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Kok W. Editorial commentary: Heart failure incidence and etiologies at young adult age. Trends Cardiovasc Med 2024; 34:89-90. [PMID: 36270488 DOI: 10.1016/j.tcm.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Wouter Kok
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands.
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2
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Islek D, Alonso A, Rosamond W, Guild CS, Butler KR, Ali MK, Manatunga A, Naimi AI, Vaccarino V. Racial Differences in Fatal Out-of-Hospital Coronary Heart Disease and the Role of Income in the Atherosclerosis Risk in Communities Cohort Study (1987 to 2017). Am J Cardiol 2023; 194:102-110. [PMID: 36914508 PMCID: PMC10079596 DOI: 10.1016/j.amjcard.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 03/16/2023]
Abstract
Black patients have higher incident fatal coronary heart disease (CHD) rates than do their White counterparts. Racial differences in out-of-hospital fatal CHD could explain the excess risk in fatal CHD among Black patients. We examined racial disparities in in- and out-of-hospital fatal CHD among participants with no history of CHD, and whether socioeconomic status might play a role in this association. We used data from the ARIC (Atherosclerosis Risk in Communities) study, including 4,095 Black and 10,884 White participants, followed between 1987 and 1989 until 2017. Race was self-reported. We examined racial differences in in- and out-of-hospital fatal CHD with hierarchical proportional hazard models. We then examined the role of income in these associations, using Cox marginal structural models for a mediation analysis. The incidence of out-of-hospital and in-hospital fatal CHD was 1.3 and 2.2 in Black participants, and 1.0 and 1.1 in White participants, respectively, per 1,000 person-years. The gender- and age-adjusted hazard ratios comparing out-of-hospital and in-hospital incident fatal CHD in Black with that in White participants were 1.65 (1.32 to 2.07) and 2.37 (1.96 to 2.86), respectively. The income-controlled direct effects of race in Black versus White participants decreased to 1.33 (1.01 to 1.74) for fatal out-of-hospital and to 2.03 (1.61 to 2.55) for fatal in-hospital CHD in Cox marginal structural models. In conclusion, higher rates of fatal in-hospital CHD in Black participants than in their White counterparts likely drive the overall racial differences in fatal CHD. Income largely explained racial differences in both fatal out-of-hospital CHD and fatal in-hospital CHD.
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Affiliation(s)
- Duygu Islek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Epidemiology, Laney Graduate School, Emory University, Atlanta, Georgia.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Wayne Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cameron S Guild
- Department of Medicine, Division of Cardiology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kenneth R Butler
- Department of Medicine: Division of Geriatrics, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Amita Manatunga
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ashley I Naimi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Salari N, Morddarvanjoghi F, Abdolmaleki A, Rasoulpoor S, Khaleghi AA, Hezarkhani LA, Shohaimi S, Mohammadi M. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:206. [PMID: 37087452 PMCID: PMC10122825 DOI: 10.1186/s12872-023-03231-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/08/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Myocardial infarction (MI) is one of the life-threatening coronary-associated pathologies characterized by sudden cardiac death. The provision of complete insight into MI complications along with designing a preventive program against MI seems necessary. METHODS Various databases (PubMed, Web of Science, ScienceDirect, Scopus, Embase, and Google scholar search engine) were hired for comprehensive searching. The keywords of "Prevalence", "Outbreak", "Burden", "Myocardial Infarction", "Myocardial Infarct", and "Heart Attack" were hired with no time/language restrictions. Collected data were imported into the information management software (EndNote v.8x). Also, citations of all relevant articles were screened manually. The search was updated on 2022.9.13 prior to the publication. RESULTS Twenty-two eligible studies with a sample size of 2,982,6717 individuals (< 60 years) were included for data analysis. The global prevalence of MI in individuals < 60 years was found 3.8%. Also, following the assessment of 20 eligible investigations with a sample size of 5,071,185 individuals (> 60 years), this value was detected at 9.5%. CONCLUSION Due to the accelerated rate of MI prevalence in older ages, precise attention by patients regarding the complications of MI seems critical. Thus, determination of preventive planning along with the application of safe treatment methods is critical.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Amir Abdolmaleki
- Department of Operating Room, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shabnam Rasoulpoor
- Department of Psychiatric Nursing, Miandoab School of Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Asghar Khaleghi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Leila Afshar Hezarkhani
- Neuroscience Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Chang J, Deng Q, Hu P, Yang Z, Guo M, Lu F, Su Y, Sun J, Qi Y, Long Y, Liu J. Driving Time to the Nearest Percutaneous Coronary Intervention-Capable Hospital and the Risk of Case Fatality in Patients with Acute Myocardial Infarction in Beijing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3166. [PMID: 36833858 PMCID: PMC9961430 DOI: 10.3390/ijerph20043166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013-2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, p value) for AMI fatality risk associated with driving times 16-30, 31-45, and >45 min were 1.068 (95% CI 1.033-1.104, p < 0.001), 1.189 (95% CI 1.127-1.255, p < 0.001), and 1.436 (95% CI 1.334-1.544, p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.
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Affiliation(s)
- Jie Chang
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Qiuju Deng
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Piaopiao Hu
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Zhao Yang
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Moning Guo
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing 100034, China
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing 100034, China
| | - Yuwei Su
- School of Urban Design, Wuhan University, Wuhan 430072, China
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Jiayi Sun
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Yue Qi
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Ying Long
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Jing Liu
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
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5
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Islek D, Alonso A, Rosamond W, Kucharska-Newton A, Mok Y, Matsushita K, Koton S, Blaha MJ, Ali MK, Manatunga A, Vaccarino V. Differences in incident and recurrent myocardial infarction among White and Black individuals aged 35 to 84: Findings from the ARIC community surveillance study. Am Heart J 2022; 253:67-75. [PMID: 35660476 PMCID: PMC10007857 DOI: 10.1016/j.ahj.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No previous study has examined racial differences in recurrent acute myocardial infarction (AMI) in a community population. We aimed to examine racial differences in recurrent AMI risk, along with first AMI risk in a community population. METHODS The community surveillance of the Atherosclerosis Risk in Communities Study (2005-2014) included 470,000 people 35 to 84 years old in 4 U.S. communities. Hospitalizations for recurrent and first AMI were identified from ICD-9-CM discharge codes. Poisson regression models were used to compare recurrent and first AMI risk ratios between Black and White residents. RESULTS Recurrent and first AMI risk per 1,000 persons were 8.8 (95% CI, 8.3-9.2) and 20.7 (95% CI, 20.0-21.4) in Black men, 6.8 (95% CI, 6.5-7.0) and 14.1 (95% CI, 13.8-14.5) in White men, 5.3 (95% CI, 5.0-5.7) and 16.2 (95% CI, 15.6-16.8) in Black women, and 3.1 (95% CI, 3.0-3.3) and 8.8 (95% CI, 8.6-9.0) in White women, respectively. The age-adjusted risk ratios (RR) of recurrent AMI were higher in Black men vs White men (RR, 1.58 95% CI, 1.30-1.92) and Black women vs White women (RR, 2.09 95% CI, 1.64-2.66). The corresponding RRs were slightly lower for first AMI: Black men vs White men, RR, 1.49 (95% CI, 1.30-1.71) and Black women vs White women, RR, 1.65 (95% CI, 1.42-1.92) CONCLUSIONS: Large disparities exist by race for recurrent AMI risk in the community. The magnitude of disparities is stronger for recurrent events than for first events, and particularly among women.
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Affiliation(s)
- Duygu Islek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Laney Graduate School, Emory University, Atlanta, GA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Wayne Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Anna Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Nursing, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Joseph Blaha
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Amita Manatunga
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA
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6
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Causes, Angiographic Characteristics, and Management of Premature Myocardial Infarction: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:2431-2449. [PMID: 35710195 DOI: 10.1016/j.jacc.2022.04.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022]
Abstract
Among patients presenting with acute myocardial infarction (AMI), the proportion of young individuals has increased in recent years. Although coronary atherosclerosis is less extensive in young patients with AMI, with higher prevalence of single-vessel disease and rare left main involvement, the long-term prognosis is not benign. Young patients with AMI with obstructive coronary artery disease have similar risk factors as older patients except for higher prevalence of smoking, lipid disorders, and family history of premature coronary artery disease, and lower prevalence of diabetes mellitus and hypertension. Smoking cessation is by far the most effective secondary preventive measure. Myocardial infarction with nonobstructive coronary arteries is a relatively common clinical entity (10%-20%) among young patients with AMI, with intravascular and cardiac magnetic resonance imaging being key for diagnosis and potentially treatment. Spontaneous coronary artery dissection is a frequent pathogenetic mechanism of AMI among young women, requiring a high degree of suspicion, especially in the peripartum period.
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7
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Sia CH, Ko J, Zheng H, Ho AFW, Foo D, Foo LL, Lim PZY, Liew BW, Chai P, Yeo TC, Yip JWL, Chua T, Chan MYY, Tan JWC, Figtree G, Bulluck H, Hausenloy DJ. Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors. Front Cardiovasc Med 2022; 9:876465. [PMID: 35497977 PMCID: PMC9047915 DOI: 10.3389/fcvm.2022.876465] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute myocardial infarction (AMI) cases have decreased in part due to the advent of targeted therapies for standard modifiable cardiovascular disease risk factors (SMuRF). Recent studies have reported that ST-elevation myocardial infarction (STEMI) patients without SMuRF (termed “SMuRF-less”) may be increasing in prevalence and have worse outcomes than “SMuRF-positive” patients. As these studies have been limited to STEMI and comprised mainly Caucasian cohorts, we investigated the changes in the prevalence and mortality of both SMuRF-less STEMI and non-STEMI (NSTEMI) patients in a multiethnic Asian population. Methods We evaluated 23,922 STEMI and 62,631 NSTEMI patients from a national multiethnic registry. Short-term cardiovascular and all-cause mortalities in SMuRF-less patients were compared to SMuRF-positive patients. Results The proportions of SMuRF-less STEMI but not of NSTEMI have increased over the years. In hospitals, all-cause and cardiovascular mortality and 1-year cardiovascular mortality were significantly higher in SMuRF-less STEMI after adjustment for age, creatinine, and hemoglobin. However, this difference did not remain after adjusting for anterior infarction, cardiopulmonary resuscitation (CPR), and Killip class. There were no differences in mortality in SMuRF-less NSTEMI. In contrast to Chinese and Malay patients, SMuRF-less patients of South Asian descent had a two-fold higher risk of in-hospital all-cause mortality even after adjusting for features of increased disease severity. Conclusion SMuRF-less patients had an increased risk of mortality with STEMI, suggesting that there may be unidentified nonstandard risk factors predisposing SMuRF-less patients to a worse prognosis. This group of patients may benefit from more intensive secondary prevention strategies to improve clinical outcomes.
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Affiliation(s)
- Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junsuk Ko
- MD Program, Duke-NUS Medical School, Singapore, Singapore
| | - Huili Zheng
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Andrew Fu-Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Pre-hospital and Emergency Care Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - David Foo
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Ling-Li Foo
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | | | | | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - James W. L. Yip
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Terrance Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Gemma Figtree
- Sydney Medical School (Northern), University of Sydney, Sydney, NSW, Australia
| | | | - Derek J. Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
- *Correspondence: Derek J. Hausenloy
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Bunsawat K, Grosicki GJ, Jeong S, Robinson AT. Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Physiological underpinnings. Prog Cardiovasc Dis 2022; 71:11-19. [PMID: 35490869 PMCID: PMC9050188 DOI: 10.1016/j.pcad.2022.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that began spreading globally in late 2019. While most cases of COVID-19 present with mild to moderate symptoms, COVID-19 was the third leading cause of mortality in the United States in 2020 and 2021. Though COVID-19 affects individuals of all races and ethnicities, non-Hispanic Black and Hispanic/Latinx populations are facing an inequitable burden of COVID-19 characterized by an increased risk for hospitalization and mortality. Importantly, non-Hispanic Black and Hispanic/Latinx adults have also faced a greater risk of non-COVID-19-related mortality (e.g., from cardiovascular disease/CVD) during the pandemic. Contributors to the racial disparities in morbidity and mortality during the pandemic are multi-factorial as we discuss in our companion article on social determinants of health. However, profound racial variation in the prevalence of CVD and metabolic diseases may serve as a key driver of worse COVID-19-related and non-COVID-19-related health outcomes among racial and ethnic minority groups. Within this review, we provide data emphasizing the inequitable burden of CVD and metabolic diseases among non-Hispanic Black and Hispanic/Latinx populations. We also discuss the pathophysiology of these conditions, with a focus on how aberrant physiological alterations in the context of CVD and metabolic diseases manifest to increase susceptibility to severe COVID-19.
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Affiliation(s)
- Kanokwan Bunsawat
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT 84132, USA; Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
| | - Gregory J Grosicki
- Department of Health Sciences and Kinesiology, Biodynamics and Human Performance Center, Georgia Southern University (Armstrong Campus), Savannah, GA 31419, USA
| | - Soolim Jeong
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, AL 36849, USA
| | - Austin T Robinson
- Neurovascular Physiology Laboratory, School of Kinesiology, Auburn University, Auburn, AL 36849, USA.
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Trends and Inequalities in the Incidence of Acute Myocardial Infarction among Beijing Townships, 2007-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312276. [PMID: 34886003 PMCID: PMC8656834 DOI: 10.3390/ijerph182312276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
Acute myocardial infarction (AMI) poses a serious disease burden in China, but studies on small-area characteristics of AMI incidence are lacking. We therefore examined temporal trends and geographic variations in AMI incidence at the township level in Beijing. In this cross-sectional analysis, 259,830 AMI events during 2007–2018 from the Beijing Cardiovascular Disease Surveillance System were included. We estimated AMI incidence for 307 consistent townships during consecutive 3-year periods with a Bayesian spatial model. From 2007 to 2018, the median AMI incidence in townships increased from 216.3 to 231.6 per 100,000, with a greater relative increase in young and middle-aged males (35–49 years: 54.2%; 50–64 years: 33.2%). The most pronounced increases in the relative inequalities was observed among young residents (2.1 to 2.8 for males and 2.8 to 3.4 for females). Townships with high rates and larger relative increases were primarily located in Beijing’s northeastern and southwestern peri-urban areas. However, large increases among young and middle-aged males were observed throughout peri-urban areas. AMI incidence and their changes over time varied substantially at the township level in Beijing, especially among young adults. Targeted mitigation strategies are required for high-risk populations and areas to reduce health disparities across Beijing.
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10
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Shah AS, Lee KK, Pérez JAR, Campbell D, Astengo F, Logue J, Gallacher PJ, Katikireddi SV, Bing R, Alam SR, Anand A, Sudlow C, Fischbacher CM, Lewsey J, Perel P, Newby DE, Mills NL, McAllister DA. Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: A 25-year individual patient level linkage study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 7:100141. [PMID: 34405203 PMCID: PMC8351196 DOI: 10.1016/j.lanepe.2021.100141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Understanding trends in the incidence and outcomes of myocardial infarction and stroke, and how these are influenced by changes in cardiovascular risk factors can inform health policy and healthcare provision. METHODS We identified all patients 30 years or older with myocardial infarction or stroke in Scotland. Risk factor levels were determined from national health surveys. Incidence, potential impact fractions and burden attributable to risk factor changes were calculated. Risk of subsequent fatal and non-fatal events (myocardial infarction, stroke, bleeding and heart failure hospitalization) were calculated with multi-state models. FINDINGS From 1990 to 2014, there were 372,873 (71±13 years) myocardial infarctions and 290,927 (74±13 years) ischemic or hemorrhagic strokes. Age-standardized incidence per 100,000 fell from 1,069 (95% confidence interval, 1,024-1,116) to 276 (263-290) for myocardial infarction and from 608 (581-636) to 188 (178-197) for ischemic stroke. Systolic blood pressure, smoking and cholesterol decreased, but body-mass index increased, and diabetes prevalence doubled. Changes in risk factors accounted for a 74% (57-91%) reduction in myocardial infarction and 68% (55-83%) reduction in ischemic stroke. Following myocardial infarction, the risk of death decreased (30% to 20%), but non-fatal events increased (20% to 24%) whereas the risk of both death (47% to 34%) and non-fatal events (22% to 17%) decreased following stroke. INTERPRETATION Over the last 25 years, substantial reductions in myocardial infarction and ischemic stroke incidence are attributable to major shifts in risk factor levels. Deaths following the index event decreased for both myocardial infarction and stroke, but rates remained substantially higher for stroke. FUNDING British heart foundation.
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Affiliation(s)
- Anoop S.V. Shah
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, United Kingdom
- Department of Cardiology, Imperial College NHS Trust, London, United Kingdom
| | - Kuan Ken Lee
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Desmond Campbell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Federica Astengo
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Peter James Gallacher
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shirjel R. Alam
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, United Kingdom
| | - Atul Anand
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Catherine Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Jim Lewsey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, United Kingdom
| | - David E. Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas L. Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David A. McAllister
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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11
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Namiuchi S, Sunamura S, Tanita A, Ushigome R, Noda K, Takii T. Higher Recurrence Rate of Acute Coronary Syndrome in Patients with Multiple-Time Myocardial Infarction. Int Heart J 2021; 62:493-498. [PMID: 33952806 DOI: 10.1536/ihj.20-546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The recurrence rate of acute coronary syndrome (ACS) in patients after first-time myocardial infarction (MI) is over ten times higher than in the general population. However, it is unclear whether patients with multiple-time MI have an even higher recurrence rate of MI. This study aimed to compare the recurrence rate in patients with multiple-time MI with the rate in patients after first-time MI. We retrospectively studied 794 consecutive MI patients who were discharged. Recurrent ACS was investigated in patients with previous MI (n = 46) and without previous MI (n = 748). During the follow-up periods (mean ± SD: 757 ± 733 days), recurrent ACS occurred in 47 cases without previous MI and in 7 cases with previous MI. Kaplan-Meier analysis revealed that the risk of recurrent ACS was significantly higher in patients with previous MI than in patients without previous MI. ACS recurrence rates one year from the onset were 4.2% in patients without previous MI and 11.9% in patients with previous MI. Landmark analysis revealed that the higher recurrence rate in patients with previous MI was as high as 14.1% from 1 year after the onset to 2 years. In conclusion, the risk of recurrent ACS may be significantly higher in patients with multiple-time MI than in patients after first-time MI.
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Affiliation(s)
- Shigeto Namiuchi
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | | | - Atsushi Tanita
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | - Ryoichi Ushigome
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | - Kazuki Noda
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
| | - Toru Takii
- Department of Cardiology, Sendai City Medical Center, Sendai Open Hospital
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12
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Eberly LA, Yang L, Eneanya ND, Essien U, Julien H, Nathan AS, Khatana SAM, Dayoub EJ, Fanaroff AC, Giri J, Groeneveld PW, Adusumalli S. Association of Race/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US. JAMA Netw Open 2021; 4:e216139. [PMID: 33856475 PMCID: PMC8050743 DOI: 10.1001/jamanetworkopen.2021.6139] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure, and progression of kidney disease among patients with type 2 diabetes. Black individuals have a disproportionate burden of cardiovascular and chronic kidney disease (CKD). Adoption of novel therapeutics has been slower among Black and female patients and among patients with low socioeconomic status than among White or male patients or patients with higher socioeconomic status. OBJECTIVE To assess whether inequities based on race/ethnicity, gender, and socioeconomic status exist in SGLT2 inhibitor use among patients with type 2 diabetes in the US. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of commercially insured patients in the US was performed from October 1, 2015, to June 30, 2019, using the Optum Clinformatics Data Mart. Adult patients with a diagnosis of type 2 diabetes, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD), or CKD, were evaluated in the analysis. MAIN OUTCOMES AND MEASURES Prescription of an SGLT2 inhibitor. Multivariable logistic regression models were used to assess the association of race/ethnicity, gender, and socioeconomic status with SGLT2 inhibitor use. RESULTS Of 934 737 patients with type 2 diabetes (mean [SD] age, 65.4 [12.9] years; 50.7% female; 57.6% White), 81 007 (8.7%) were treated with an SGLT2 inhibitor during the study period. Between 2015 and 2019, the percentage of patients with type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%. Among patients with type 2 diabetes and cardiovascular or kidney disease, the rate of SGLT2 inhibitor use increased but was lower than that among all patients with type 2 diabetes (HFrEF: 1.9% to 7.6%; ASCVD: 3.0% to 9.8%; CKD: 2.1% to 7.5%). In multivariable analyses, Black race (adjusted odds ratio [aOR], 0.83; 95% CI, 0.81-0.85), Asian race (aOR, 0.94; 95% CI, 0.90-0.98), and female gender (aOR, 0.84; 95% CI, 0.82-0.85) were associated with lower rates of SGLT2 inhibitor use, whereas higher median household income (≥$100 000: aOR, 1.08 [95% CI, 1.05-1.10]; $50 000-$99 999: aOR, 1.05 [95% CI, 1.03-1.07] vs <$50 000) was associated with a higher rate of SGLT2 inhibitor use. These results were similar among patients with HFrEF, ASCVD, and CKD. CONCLUSIONS AND RELEVANCE In this cohort study, use of an SGLT2 inhibitor treatment increased among patients with type 2 diabetes from 2015 to 2019 but remained low, particularly among patients with HFrEF, CKD, and ASCVD. Black and female patients and patients with low socioeconomic status were less likely to receive an SGLT2 inhibitor, suggesting that interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes in the US.
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Affiliation(s)
- Lauren A. Eberly
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Lin Yang
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
| | - Nwamaka D. Eneanya
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Utibe Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Howard Julien
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
| | - Ashwin S. Nathan
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Sameed Ahmed M. Khatana
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elias J. Dayoub
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
| | - Alexander C. Fanaroff
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Jay Giri
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Peter W. Groeneveld
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Srinath Adusumalli
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
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13
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Abstract
PURPOSE OF REVIEW Significant racial and ethnic healthcare disparities exist in the management and outcomes of patients with acute myocardial infarction (AMI). This review will highlight the recent studies focusing on disparities in AMI care and how practice patterns have changed over time, and discuss solutions and future directions to overcome disparities in AMI care. RECENT FINDINGS AMI continues to be a leading cause of morbidity and mortality in the USA. Racial and ethnic disparities continue to be present in the care and outcomes associated with AMI. Non-white individuals continue to receive less guideline-concordant care and experience higher rates of adverse outcomes compared with white individuals. Health policy and quality improvement interventions have helped to narrow the gap; however, ongoing efforts are needed to continue to attempt to eliminate this disparity. Racial and ethnic disparities persist in the presentation, management, and outcomes of patients with AMI. Improvements in care have narrowed some of the inequalities. Ongoing research and efforts directed at improving access to care, eliminating bias in healthcare, and focusing on coronary heart disease prevention are needed to eliminate disparities.
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14
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Crimmins EM, Zhang YS, Kim JK, Levine ME. Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2020; 74:S21-S26. [PMID: 31724057 DOI: 10.1093/gerona/glz075] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study. METHODS We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years. RESULTS The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke. DISCUSSION While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive.
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Affiliation(s)
- Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Yuan S Zhang
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Jung Ki Kim
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Morgan E Levine
- Department of Pathology, School of Medicine, Yale University, New Haven, Connecticut
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15
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Mohamed Bakrim N, Mohd Shah ANS, Talib NA, Ab Rahman J, Abdullah A. Identification of Haptoglobin as a Potential Biomarker in Young Adults with Acute Myocardial Infarction by Proteomic Analysis. Malays J Med Sci 2020; 27:64-76. [PMID: 32788843 PMCID: PMC7409576 DOI: 10.21315/mjms2020.27.2.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/22/2020] [Indexed: 01/01/2023] Open
Abstract
Background Acute myocardial infarction (AMI) molecular research in young adults is still limited. The aim of this study is to identify AMI proteomic biomarker(s) in young adults. Methods This study comprised of two phases namely discovery and verification. In the discovery phase, proteins in the pooled plasma samples from young male adults between 18 and 45 years (10 AMI patients and 10 controls) were separated using two-dimensional electrophoresis. The protein spots that were expressed differently in the AMI patients were identified via matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. The plasma concentrations of these proteins were quantified using enzyme-linked immunosorbent assay during the verification phase (40 AMI patients and 80 controls). Results Haptoglobin (Hp), apolipoprotein AI (Apo AI) and apolipoprotein AIV (Apo AIV) were up-regulated in the discovery phase. In the verification phase, the plasma concentration of Hp was significantly higher in AMI patients than the controls (P < 0.001). Logistic regression showed an association between Hp and AMI in young adults (odds ratio [OR] = 1.016, 95% CI: 1.002–1.030, P = 0.025) independent of other AMI risk factors. Hp was significantly correlated with high sensitivity C-reactive protein (hs-CRP) (r = 0.424, P < 0.001). Conclusion In young adults with AMI, plasma Hp concentrations were elevated and it is independently associated with AMI. A positive correlation with hs-CRP suggests Hp could be a potential biomarker of AMI in young adults.
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Affiliation(s)
- Norbaiyah Mohamed Bakrim
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Aida Nur Sharini Mohd Shah
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Norlelawati A Talib
- Department of Pathology and Laboratory Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Jamalludin Ab Rahman
- Department of Community Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
| | - Aszrin Abdullah
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
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16
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Bossard M, Latifi Y, Fabbri M, Kurmann R, Brinkert M, Wolfrum M, Berte B, Cuculi F, Toggweiler S, Kobza R, Chamberlain AM, Moccetti F. Increasing Mortality From Premature Coronary Artery Disease in Women in the Rural United States. J Am Heart Assoc 2020; 9:e015334. [PMID: 32316803 PMCID: PMC7428560 DOI: 10.1161/jaha.119.015334] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Previous reports have described a leveling off of mortality from premature coronary artery disease (CAD). In recent years, the prevalence of cardiovascular risk factors has increased in rural communities and young adults. Methods and Results We extracted CAD mortality rates from the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2017, focusing on mortality from premature CAD (defined as <65 years of age in women) and urban–rural differences. Variations in mortality rates over time, assessed with Joinpoint regression modeling, are expressed as estimated annual percentage change (95% CI) and stratified by urbanization, sex, age, and race. Age‐adjusted mortality rates decreased for women and men. Stratification by urbanization revealed that premature CAD mortality is stagnating among women in rural areas. However, this stagnation conceals a statistically significant increase in CAD mortality rates since 2009 in women aged 55 to 64 years (estimated annual percentage change: +1.4%; 95% CI, +0.3% to +2.5%) and since 1999 in women aged 45 to 54 years (estimated annual percentage change: +0.6%; 95% CI, +0.2% to 1.0%). Since 1999, mortality has been stagnating in the youngest group (aged 35–44 years; estimated annual percentage change: +0.2%; 95% CI, −0.4% to +0.8%). Stratification by race indicated an increase in mortality rates among white rural women. Premature CAD mortality remains consistently higher in the rural versus urban United States, regardless of sex, race, and age group. Conclusions Premature CAD mortality rates have declined over time. However, stratification by sex and urbanization reveals disparities that would otherwise remain concealed: CAD mortality rates have increased among women from rural areas since at least 2009.
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Affiliation(s)
- Matthias Bossard
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Yllka Latifi
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR.,Department of Cardiology Triemli Hospital Zurich Switzerland
| | - Matteo Fabbri
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Reto Kurmann
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland.,Department of Cardiology Triemli Hospital Zurich Switzerland
| | - Miriam Brinkert
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | | | - Benjamin Berte
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Florim Cuculi
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Stefan Toggweiler
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Richard Kobza
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | | | - Federico Moccetti
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland.,Knight Cardiovascular Institute Oregon Health & Science University Portland OR
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17
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Incidence of Ischaemic Heart Disease in Men and Women With End-Stage Kidney Disease: A Cohort Study. Heart Lung Circ 2020; 29:1517-1526. [PMID: 32253129 DOI: 10.1016/j.hlc.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/08/2019] [Accepted: 03/01/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The incidence of ischaemic heart disease (IHD) has fallen consistently in the general population; attributed to effective primary prevention strategies. Differences in incidence have been demonstrated by sex. Whether this fall in incidence and sex differences is mirrored in people with end-stage kidney disease (ESKD) is unclear. We aimed to establish the relative risk of IHD events in the ESKD population. METHODS We performed a retrospective cohort study from 2000 to 2010 in people with ESKD in New South Wales. We performed data linkage of the Australia and New Zealand Dialysis and Transplant Registry and state wide hospital admission and death registry data and compared this to general population data. The primary outcome was the incidence rate, incidence rate ratio (IRR), and time-trend for any IHD event. We calculated these using indirect standardisation by IHD event. RESULTS 10,766 participants, contributed 44,149 years of observation time. Incidence rates were substantially higher than the general population for all IHD events (any IHD event: IRR 1.8, 95% confidence interval [CI] 1.7-1.9 for men, IRR 3.4, 95% CI 3.1-3.6 for women). Excess risk was higher in younger people (age 30-49 IRR 4.8, 95% CI 4.2-5.4), and in women with a three-fold increase risk overall and nearly a 10-fold increase in risk in young women (female age 30-49 years: IRR 9.8 95% CI 7.7-12.3), results were similar for angina and acute myocardial infarction. Ischaemic heart disease rates showed some decline for men over time, (ratio of IRR 0.93, 95% CI 0.90-0.95) but were stable for women (ratio of IRR 0.97, 95% CI 0.94-1.01). CONCLUSIONS People with ESKD have substantially higher rates of IHD than the general population, especially women, in whom no improvement appears evident over the past 10 years.
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18
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Chi GC, Kanter MH, Li BH, Qian L, Reading SR, Harrison TN, Jacobsen SJ, Scott RD, Cavendish JJ, Lawrence JM, Tartof SY, Reynolds K. Trends in Acute Myocardial Infarction by Race and Ethnicity. J Am Heart Assoc 2020; 9:e013542. [PMID: 32114888 PMCID: PMC7335574 DOI: 10.1161/jaha.119.013542] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Trends in acute myocardial infarction (AMI) incidence rates for diverse races/ethnicities are largely unknown, presenting barriers to understanding the role of race/ethnicity in AMI occurrence. Methods and Results We identified AMI hospitalizations for Kaiser Permanente Southern California members, aged ≥35 years, during 2000 to 2014 using discharge diagnostic codes. We excluded hospitalizations with missing race/ethnicity information. We calculated annual incidence rates (age and sex standardized to the 2010 US census population) for AMI, ST‐segment–elevation myocardial infarction, and non–ST‐segment–elevation myocardial infarction by race/ethnicity (Hispanic and non‐Hispanic racial groups: Asian or Pacific Islander, black, and white). Using Poisson regression, we estimated annual percentage change in AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction incidence by race/ethnicity and AMI incidence rate ratios between race/ethnicity pairs, adjusting for age and sex. We included 18 630 776 person‐years of observation and identified 44 142 AMI hospitalizations. During 2000 to 2014, declines in AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction were 48.7%, 34.2%, and 69.8%, respectively. Age‐ and sex‐standardized AMI hospitalization rates/100 000 person‐years declined for Hispanics (from 307 to 162), Asians or Pacific Islanders (from 271 to 158), blacks (from 347 to 199), and whites (from 376 to 189). Annual percentage changes ranged from −2.99% to −4.75%, except for blacks, whose annual percentage change was −5.32% during 2000 to 2009 and −1.03% during 2010 to 2014. Conclusions During 2000 to 2014, AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction hospitalization incidence rates declined substantially for each race/ethnic group. Despite narrowing rates among races/ethnicities, differences persist. Understanding these differences can help identify unmet needs in AMI prevention and management to guide targeted interventions.
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Affiliation(s)
- Gloria C Chi
- Epidemic Intelligence Service Division of Scientific Education and Professional Development Centers for Disease Control and Prevention Atlanta GA.,Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Michael H Kanter
- Southern California Permanente Medical Group Pasadena CA.,Department of Clinical Science Kaiser Permanente School of Medicine Pasadena CA
| | - Bonnie H Li
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Lei Qian
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Stephanie R Reading
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA.,Amgen Inc Thousand Oaks CA
| | - Teresa N Harrison
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Steven J Jacobsen
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | | | | | - Jean M Lawrence
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Sara Y Tartof
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Kristi Reynolds
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
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19
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Odoi EW, Nagle N, DuClos C, Kintziger KW. Disparities in Temporal and Geographic Patterns of Myocardial Infarction Hospitalization Risks in Florida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4734. [PMID: 31783516 PMCID: PMC6926732 DOI: 10.3390/ijerph16234734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and 2014. This study used retrospective data on MI hospitalizations that occurred among Florida residents between 2005 and 2014. We identified spatial clusters of hospitalization risks using Kulldorff's circular and Tango's flexible spatial scan statistics. Counties with persistently high or low MI hospitalization risks were identified. There was a 20% decline in hospitalization risks during the study period. However, we found persistent clustering of high risks in the Big Bend region, South Central and southeast Florida, and persistent clustering of low risks primarily in the South. Risks decreased by 7%-21% in high-risk clusters and by 9%-28% in low-risk clusters. The risk decreased in the high-risk cluster in the southeast but increased in the Big Bend area during the last four years of the study. Overall, risks in low-risk clusters were ahead those for high-risk clusters by at least 10 years. Despite MI risk declining over the study period, disparities in MI risks persist. Eliminating/reducing those disparities will require prioritizing high-risk clusters for interventions.
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Affiliation(s)
- Evah W. Odoi
- Comparative and Experimental Medicine, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Nicholas Nagle
- Department of Geography, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Chris DuClos
- Environmental Public Health Tracking, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL 32399, USA;
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20
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White HD. Adjunctive antithrombotic therapy with primary percutaneous coronary intervention in ST elevation myocardial infarction: ATOLL in perspective. Eur Heart J 2019; 40:e4-e7. [PMID: 21990262 DOI: 10.1093/eurheartj/ehq317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag, Auckland, New Zealand
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21
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Goldberg RJ, Tisminetzky M, Tran HV, Yarzebski J, Lessard D, Gore JM. Decade Long Trends (2001-2011) in the Incidence Rates of Initial Acute Myocardial Infarction. Am J Cardiol 2019; 123:206-211. [PMID: 30409411 DOI: 10.1016/j.amjcard.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022]
Abstract
Despite the magnitude and impact of acute coronary disease, there are limited population-based data in the United States describing relatively recent trends in the incidence rates of acute myocardial infarction (AMI). The objectives of this study were to describe decade long (2001-2011) trends in the incidence rates of initial hospitalized episodes of AMI, with further stratification of these rates by age, sex, and type of AMI, in residents of central Massachusetts hospitalized at 11 area medical centers. The study population consisted of 3,737 adults hospitalized with a first AMI at 11 medical centers in central Massachusetts on a biennial basis between 2001 and 2011. The median age of this study population was 70 years, 57% were men, and 90% were white. Patients hospitalized during the most recent study years (2009/11) were younger, more likely to be men, have more co-morbidities, and less in-hospital complications as compared with those in the earliest study years (2001/03). The overall age-adjusted hospital incidence rates (per 100,000 persons) of initial AMI declined (from 319 to 163), for men (from 422 to 219), women (from 232 to 120), for patients with a ST segment elevation (129 to 56), and for those with an non-ST segment elevation (190 to 107) between 2001 and 2011, respectively. In conclusion, the incidence rates of initial AMI declined appreciably in residents of central Massachusetts who were hospitalized with AMI during the years under study.
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Affiliation(s)
- Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Meyers Primary Care Institute and the Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hoang V Tran
- Department of Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel M Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Keohane LM, Gambrel RJ, Freed SS, Stevenson D, Buntin MB. Understanding Trends in Medicare Spending, 2007-2014. Health Serv Res 2018; 53:3507-3527. [PMID: 29512154 PMCID: PMC6153172 DOI: 10.1111/1475-6773.12845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To analyze the sources of per-beneficiary Medicare spending growth between 2007 and 2014, including the role of demographic characteristics, attributes of Medicare coverage, and chronic conditions. DATA SOURCES Individual-level Medicare spending and enrollment data. STUDY DESIGN Using an Oaxaca-Blinder decomposition model, we analyzed whether changes in price-standardized, per-beneficiary Medicare Part A and B spending reflected changes in the composition of the Medicare population or changes in relative spending levels per person. DATA EXTRACTION METHODS We identified a 5 percent sample of fee-for-service Medicare beneficiaries age 65 and above from years 2007 to 2014. RESULTS Mean payment-adjusted Medicare per-beneficiary spending decreased by $180 between the 2007-2010 and 2011-2014 time periods. This decline was almost entirely attributable to lower spending levels for beneficiaries. Notably, declines in marginal spending levels for beneficiaries with chronic conditions were associated with a $175 reduction in per-beneficiary spending. The decline was partially offset by the increasing prevalence of certain chronic diseases. Still, we are unable to attribute a large share of the decline in spending levels to observable beneficiary characteristics or chronic conditions. CONCLUSIONS Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth.
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Affiliation(s)
- Laura M. Keohane
- Department of Health PolicyVanderbilt University School of MedicineNashvilleTN
| | - Robert J. Gambrel
- Department of Health PolicyVanderbilt University School of MedicineNashvilleTN
| | - Salama S. Freed
- Department of Health PolicyVanderbilt University School of MedicineNashvilleTN
- Department of EconomicsVanderbilt UniversityNashvilleTN
| | - David Stevenson
- Department of Health PolicyVanderbilt University School of MedicineNashvilleTN
| | - Melinda B. Buntin
- Department of Health PolicyVanderbilt University School of MedicineNashvilleTN
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Impact of the Regional Network for AMI in the Management of STEMI on Care Processes, Outcomes and Health Inequities in the Veneto Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091980. [PMID: 30208613 PMCID: PMC6163929 DOI: 10.3390/ijerph15091980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/07/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022]
Abstract
Cardiovascular diseases are a leading cause of death in Europe. Outcomes in terms of mortality and health equity in the management of patients with ST-Elevation Myocardial Infarction (STEMI) are influenced by health care service organization. The main aim of the present study was to examine the impact of the new organizational model of the Veneto Region’s network for Acute Myocardial Infarction (AMI) to facilitate primary percutaneous coronary intervention (PCI) on STEMI, and its efficacy in reducing health inequities. A retrospective cohort study was conducted on HDRs in the Veneto Region for the period 2007–2016, analyzing 65,261 hospitalizations for AMI. The proportion of patients with STEMI treated with PCI within 24 h increased significantly for men and women, and was statistically much higher for patients over 75 years of age (APC, 75–84: 9.8; >85: 12.5) than for younger patients (APC, <45: 3.3; 45–64: 4.9), with no difference relating to citizenship. The reduction in in-hospital, STEMI-related mortality was only statistically significant for patients aged 75–84 (APC: −3.0 [−4.5;−1.6]), and for Italians (APC: −1.9 [−3.2;−0.6]). Multivariate analyses confirmed a reduction in the disparities between socio-demographic categories. Although the new network improved the care process and reduced health care disparities in all subgroups, these efforts did not result in the expected survival benefit in all patient subgroups.
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Burchill LJ, Gao L, Kovacs AH, Opotowsky AR, Maxwell BG, Minnier J, Khan AM, Broberg CS. Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease-Related Heart Failure. J Am Heart Assoc 2018; 7:e008775. [PMID: 30371225 PMCID: PMC6201452 DOI: 10.1161/jaha.118.008775] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/22/2018] [Indexed: 02/05/2023]
Abstract
Background This study assessed trends in heart failure ( HF) hospitalizations and health resource use in patients with adult congenital heart disease ( ACHD ). Methods and Results The Nationwide Inpatient Sample was used to compare ACHD with non- ACHD HF hospitalization and health resource trends. Health resource use was assessed using total hospital charges, hospital length of stay, and procedural burden. A total of 87 175±2676 ACHD -related HF hospitalizations occurred between 1998 and 2011. During this time, ACHD HF hospitalizations increased 91% (4620±438-8809±740, P<0.0001) versus a 21% increase in non- ACHD HF hospitalizations ( P=0.003). ACHD HF hospitalization was associated with longer length of stay ( ACHD HF versus non- ACHD HF, 7.2±0.09 versus 6.8±0.02 days; P<0.0001), greater procedural burden, and higher charges ($81 332±$1650 versus $52 050±$379; P<0.0001). ACHD HF hospitalization charges increased 258% during the study period ($26 533±$1816 in 1998 versus $94 887±$8310 in 2011; P=0.0002), more than double that for non- ACHD HF ( P=0.04). Patients with ACHD HF hospitalized in high-volume ACHD centers versus others were more likely to undergo invasive hemodynamic testing (30.2±0.6% versus 20.7±0.5%; P<0.0001) and to receive cardiac resynchronization/defibrillator devices (4.7±0.3% versus 1.8±0.2%; P<0.0001) and mechanical circulatory support (3.9±0.2% versus 2.4±0.2%; P<0.0001). Conclusions ACHD -related HF hospitalizations have increased dramatically in recent years and are associated with disproportionately higher costs, procedural burden, and health resource use.
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Affiliation(s)
- Luke J. Burchill
- Adult Congenital Heart Disease ProgramKnight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Lina Gao
- Adult Congenital Heart Disease ProgramKnight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Adrienne H. Kovacs
- Adult Congenital Heart Disease ProgramKnight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | | | - Bryan G. Maxwell
- Legacy Emanuel Medical Center and Randall Children's HospitalPortlandOR
| | - Jessica Minnier
- Adult Congenital Heart Disease ProgramKnight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Abigail M. Khan
- Adult Congenital Heart Disease ProgramKnight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Craig S. Broberg
- Adult Congenital Heart Disease ProgramKnight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
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25
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Khan S, Hanif A, Wilson MF. Ischaemic cardiomyopathy and embolic stroke in a young adult with suspected synthetic cannabinoid use. BMJ Case Rep 2018; 2018:bcr-2018-224755. [PMID: 29880579 DOI: 10.1136/bcr-2018-224755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The incidence of cardiovascular disease is increasing in young adults. We are reporting a case of acute stroke in a young patient with severe ischaemic cardiomyopathy in the absence of traditional risk factors. After ruling out atherosclerotic disease, his presentation was attributed to synthetic cannabinoid use. We then discussed the typical barriers in early diagnosis and limitations of laboratory testing in this condition. Due to the increase in abuse of these synthetic drugs among young adults, there is a need for high clinical suspicion which can help with early recognition and improve morbidity and mortality associated with these chemicals.
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Affiliation(s)
- Sumera Khan
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Ahmad Hanif
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Michael F Wilson
- University at Buffalo - The State University of New York, Buffalo, New York, USA.,Nuclear Cardiology and Cardiovascular Computed Tomography, Kaleida Health Hospitals, Buffalo, NY, USA
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26
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Sinha SS, Sjoding MW, Sukul D, Prescott HC, Iwashyna TJ, Gurm HS, Cooke CR, Nallamothu BK. Changes in Primary Noncardiac Diagnoses Over Time Among Elderly Cardiac Intensive Care Unit Patients in the United States. Circ Cardiovasc Qual Outcomes 2018; 10:e003616. [PMID: 28794121 DOI: 10.1161/circoutcomes.117.003616] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/31/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Early reports suggest the number of cardiac intensive care unit (CICU) patients with primary noncardiac diagnoses is rising in the United States, but no national data currently exist. We examined changes in primary noncardiac diagnoses among elderly patients admitted to a CICU during the past decade. METHODS AND RESULTS Using 2003 to 2013 Medicare data, we grouped elderly patients admitted to CICUs into 2 categories based on principal diagnosis at discharge: (1) primary noncardiac diagnoses and (2) primary cardiac diagnoses. We examined changes in patient demographics, comorbidities, procedure use, and risk-adjusted in-hospital mortality. Among 3.4 million admissions with a CICU stay, primary noncardiac diagnoses rose in prevalence from 38.0% to 51.7% between 2003 and 2013. The fastest rising primary noncardiac diagnoses were infectious diseases (7.8%-15.1%) and respiratory diseases (6.0%-7.6%; P<0.001 for both), whereas the fastest declining primary cardiac diagnosis was coronary artery disease (32.3%-19.0%; P<0.001). Simultaneously, the prevalence of both cardiovascular and noncardiovascular comorbidities rose: heart failure (13.9%-34.4%), pulmonary vascular disease (1.2%-7.1%), valvular heart disease (5.0%-9.8%), and renal failure (7.1%-19.6%; P<0.001 for all). As compared with those with primary cardiac diagnoses, elderly CICU patients with primary noncardiac diagnoses had higher rates of noncardiac procedure use and risk-adjusted in-hospital mortality (P<0.001 for all). Risk-adjusted in-hospital mortality declined slightly in the overall cohort from 9.3% to 8.9% (P<0.001). CONCLUSIONS More than half of all elderly patients with a CICU stay across the United States now have primary noncardiac diagnoses at discharge. These patients receive different types of care and have worse outcomes than patients with primary cardiac diagnoses. Our work has important implications for the development of appropriate training and staffing models for the future critical care workforce.
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Affiliation(s)
- Shashank S Sinha
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.).
| | - Michael W Sjoding
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.)
| | - Devraj Sukul
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.)
| | - Hallie C Prescott
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.)
| | - Theodore J Iwashyna
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.)
| | - Hitinder S Gurm
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.)
| | - Colin R Cooke
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.)
| | - Brahmajee K Nallamothu
- From the Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center (S.S.S., D.S., H.S.G., B.K.N.), Division of Pulmonary and Critical Care Medicine (M.W.S., H.C.P., T.J.I., C.R.C.), Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation (S.S.S., M.W.S., H.C.P., T.J.I., B.K.N.), and Michigan Center for Integrative Research in Critical Care (S.S.S., M.W.S., H.C.P., T.J.I., C.R.C., B.K.N.), University of Michigan, Ann Arbor; and Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, MI (H.C.P., T.J.I., H.S.G., B.K.N.)
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Nadruz W, Claggett B, Henglin M, Shah AM, Skali H, Rosamond WD, Folsom AR, Solomon SD, Cheng S. Widening Racial Differences in Risks for Coronary Heart Disease. Circulation 2018; 137:1195-1197. [PMID: 29530895 PMCID: PMC5854206 DOI: 10.1161/circulationaha.117.030564] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wilson Nadruz
- Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.).
| | - Brian Claggett
- Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.)
| | - Mir Henglin
- Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.)
| | - Amil M Shah
- Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.)
| | - Hicham Skali
- Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.)
| | - Wayne D Rosamond
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.C., M.H., A.M.S., H.S., S.D.S., S.C.)
| | - Aaron R Folsom
- Department of Epidemiology, University of North Carolina, Chapel Hill (W.D.R.)
| | - Scott D Solomon
- Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.)
| | - Susan Cheng
- Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.).
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Ho V, Ross JS, Steiner CA, Mandawat A, Short M, Ku-Goto MH, Krumholz HM. A Nationwide Assessment of the Association of Smoking Bans and Cigarette Taxes With Hospitalizations for Acute Myocardial Infarction, Heart Failure, and Pneumonia. Med Care Res Rev 2017; 74:687-704. [PMID: 27624634 PMCID: PMC5665160 DOI: 10.1177/1077558716668646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/05/2016] [Accepted: 08/05/2016] [Indexed: 11/17/2022]
Abstract
Multiple studies claim that public place smoking bans are associated with reductions in smoking-related hospitalization rates. No national study using complete hospitalization counts by area that accounts for contemporaneous controls including state cigarette taxes has been conducted. We examine the association between county-level smoking-related hospitalization rates and comprehensive smoking bans in 28 states from 2001 to 2008. Differences-in-differences analysis measures changes in hospitalization rates before versus after introducing bans in bars, restaurants, and workplaces, controlling for cigarette taxes, adjusting for local health and provider characteristics. Smoking bans were not associated with acute myocardial infarction or heart failure hospitalizations, but lowered pneumonia hospitalization rates for persons ages 60 to 74 years. Higher cigarette taxes were associated with lower heart failure hospitalizations for all ages and fewer pneumonia hospitalizations for adults aged 60 to 74. Previous studies may have overestimated the relation between smoking bans and hospitalizations and underestimated the effects of cigarette taxes.
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Affiliation(s)
- Vivian Ho
- Rice University, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
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29
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Saner H, Mollet JD, Berlin C, Windecker S, Meier B, Räber L, Zwahlen M, Stute P. No significant gender difference in hospitalizations for acute coronary syndrome in Switzerland over the time period of 2001 to 2010. Int J Cardiol 2017; 243:59-64. [DOI: 10.1016/j.ijcard.2017.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/21/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
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30
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Kones R, Rumana U. Cardiometabolic diseases of civilization: history and maturation of an evolving global threat. An update and call to action. Ann Med 2017; 49:260-274. [PMID: 27936950 DOI: 10.1080/07853890.2016.1271957] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite striking extensions of lifespan, leading causes of death in most countries now constitute chronic, degenerative diseases which outpace the capacity of health systems. Cardiovascular disease is the most common cause of death in both developed and undeveloped countries. In America, nearly half of the adult population has at least one chronic disease, and polypharmacy is commonplace. Prevalence of ideal cardiovascular health has not meaningfully improved over the past two decades. The fall in cardiovascular deaths in Western countries, half due to a fall in risk factors and half due to improved treatments, have plateaued, and this reversal is due to the dual epidemics of obesity and diabetes type 2. High burdens of cardiovascular risk factors are also evident globally. Undeveloped nations bear the burdens of both infectious diseases and high childhood death rates. Unacceptable rates of morbidity and mortality arise from insufficient resources to improve sanitation, pure water, and hygiene, ultimately linked to poverty and disparities. Simultaneously, about 80% of cardiovascular deaths now occur in low- and middle-income nations. For these reasons, risk factors for noncommunicable diseases, including poverty, health illiteracy, and lack of adherence, must be targeted with unprecedented vigor worldwide. Key messages In developed and relatively wealthy countries, chronic "degenerative" diseases have attained crisis proportions that threaten to reverse health gains made within the past decades. Although poverty, disparities, and poor sanitation still cause unnecessary death and despair in developing nations, they are now also burdened with increasing cardiovascular mortality. Poor adherence and low levels of health literacy contribute to the high background levels of cardiovascular risk.
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Affiliation(s)
- Richard Kones
- a Cardiology Section , The Cardiometabolic Research Institute , Houston , TX , USA
| | - Umme Rumana
- a Cardiology Section , The Cardiometabolic Research Institute , Houston , TX , USA
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31
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Chen CL, Yen DHT, Lin CS, Tsai SH, Chen SJ, Sheu WHH, Hsu CW. Glycated hemoglobin level is an independent predictor of major adverse cardiac events after nonfatal acute myocardial infarction in nondiabetic patients: A retrospective observational study. Medicine (Baltimore) 2017; 96:e6743. [PMID: 28471967 PMCID: PMC5419913 DOI: 10.1097/md.0000000000006743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The effect of glycemic control on the prognosis of nondiabetic patients after acute myocardial infarction (AMI) remains uncertain. We investigated whether glycated hemoglobin (HbA1c) is associated with adverse outcomes after AMI in nondiabetic patients. In this observational study, we enrolled nondiabetic patients with AMI in the emergency department of 2 medical centers from January 2011 to September 2014. All patients received primary percutaneous coronary intervention and were divided into 4 groups according to the interquartile range of average HbA1c level (Group I, ≤5.6%; Group II, 5.6%-5.8%; Group III, 5.8%-6.0%; and Group IV, >6.0%). Multivariate logistic analysis was performed to estimate the correlation of HbA1c with major adverse cardiac events (MACEs) after AMI. In total, 267 eligible patients were enrolled; 48 patients (18%) developed MACEs within a median follow-up of 178 days. Univariate analysis showed HbA1c > 6.0%, with a higher risk of MACEs in Group IV than in Group I (odds ratio [OR]: 2.733; 95% confidence interval [CI]: 1.123-6.651 vs OR: 1.511; 95% CI: 0.595-3.835). Multivariate analysis revealed an approximately 3.8 times higher risk of MACEs in Group IV than in Group I (OR: 3.769; 95% CI: 1.30-10.86). The HbA1 level is a significant predictor of MACEs after AMI in nondiabetic patients.
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Affiliation(s)
- Chin-Lan Chen
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University
| | - David H.-T. Yen
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University
- Department of Emergency Medicine, Taipei Veterans General Hospital
| | | | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei
| | - Wayne H.-H. Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Chin-Wang Hsu
- Department of Emergency and Critical Medicine, Wan Fang Hospital
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Cacciani L, Agabiti N, Bargagli AM, Davoli M. Access to percutaneous transluminal coronary angioplasty and 30-day mortality in patients with incident STEMI: Differentials by educational level and gender over 11 years. PLoS One 2017; 12:e0175038. [PMID: 28384181 PMCID: PMC5383153 DOI: 10.1371/journal.pone.0175038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background Socioeconomic status and gender are associated with access to cardiac procedures and mortality after AMI, also in countries with universal health care systems. Our objective was to evaluate the association and trends of educational level or gender and the following outcomes: 1) access to PTCA; 2) 30-day mortality. Methods We conducted an observational study based on 14,013 subjects aged 35–74 years, residing in Rome in 2001, and hospitalised for incident STEMI within 2012 in the Lazio region. We estimated adjusted ORs of educational level or gender and: 1) PTCA within 2 days after hospitalisation, 2) 30-day mortality. We evaluated time trends of outcomes, and time trends of educational or gender differentials estimating ORs stratified by time period (two time periods between 2001 and 2012). We performed a hierarchical analysis to account for clustering of hospitals. Results Access to PTCA among patients with incident STEMI increased during the study period, while 30-day mortality was stable. We observed educational differentials in PTCA procedure only in the first time period, and gender differentials in both periods. Patterns for 30-day mortality were less marked, with educational differentials emerging only in the second period, and gender differentials only in the first one, with patients with low educational level and females being disadvantaged. Conclusions Educational differentials in the access to PTCA disappeared in Lazio region over time, coherently with scientific literature, while gender differentials seem to persist. It may be important to assess the role of female gender in patients with STEMI, both from a social and a clinical point of view.
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Affiliation(s)
- Laura Cacciani
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Anna Maria Bargagli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
- * E-mail:
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Frigerio M, Mazzali C, Paganoni AM, Ieva F, Barbieri P, Maistrello M, Agostoni O, Masella C, Scalvini S. Trends in heart failure hospitalizations, patient characteristics, in-hospital and 1-year mortality: A population study, from 2000 to 2012 in Lombardy. Int J Cardiol 2017; 236:310-314. [PMID: 28262349 DOI: 10.1016/j.ijcard.2017.02.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study was undertaken to evaluate trends in heat failure hospitalizations (HFHs) and 1-year mortality of HFH in Lombardy, the largest Italian region, from 2000 to 2012. METHODS Hospital discharge forms with HF-related ICD-9 CM codes collected from 2000 to 2012 by the regional healthcare service (n=699797 in 370538 adult patients), were analyzed with respect to in-hospital and 1-year mortality; Group (G) 1 included most acute HF episodes with primary cardiac diagnosis (70%); G2 included cardiomyopathies without acute HF codes (17%); and G3 included non-cardiac conditions with HF as secondary diagnosis (13%). Patients experiencing their first HFH since 2005 were analyzed as incident cases (n=216782). RESULTS Annual HFHs number (mean 53830) and in-hospital mortality (9.4%) did not change over the years, the latter being associated with increasing age (p<0.0001) and diagnosis Group (G1 9.1%, G2 5.6%, G3 15.9%, p<0.0001). Incidence of new cases decreased over the years (3.62 [CI 3.58-3.67] in 2005 to 3.13 [CI 3.09-3.17] in 2012, per 1000 adult inhabitants/year, p<0.0001), with an increasing proportion of patients aged ≥85y (22.3% to 31.4%, p<0.0001). Mortality lowered over time in <75y incident cases, both in-hospital (5.15% to 4.36%, p<0.0001) and at 1-year (14.8% to 12.9%, p=0.0006). CONCLUSIONS The overall burden and mortality of HFH appear stable for more than a decade. However, from 2005 to 2012, there was a reduction of new, incident cases, with increasing age at first hospitalization. Meanwhile, both in-hospital and 1-year mortality decreased in patients aged <75y, possibly due to improved prevention and treatment.
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Affiliation(s)
- Maria Frigerio
- De Gasperis Cardiocenter, Niguarda-Ca'Granda Hospital, Milan, Italy
| | - Cristina Mazzali
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | | | - Francesca Ieva
- MOX - Department of Mathematics, Politecnico di Milano, Milan, Italy
| | | | | | - Ornella Agostoni
- Cardiovascular Department, Santi Paolo e Carlo, Presidio San Carlo, Milan, Italy
| | - Cristina Masella
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Simonetta Scalvini
- Rehabilitation Cardiology Department and Continuity Care Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy.
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Yang E, Stokes M, Johansson S, Mellström C, Magnuson E, Cohen DJ, Hunt P. Clinical and economic outcomes among elderly myocardial infarction survivors in the United States. Cardiovasc Ther 2017; 34:450-459. [PMID: 27564212 DOI: 10.1111/1755-5922.12222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Longitudinal data are limited regarding outcomes and costs beyond 1 year after acute myocardial infarction (MI) among elderly (≥65 years old) US patients. This study examined long-term outcomes and healthcare costs among elderly MI survivors. METHODS Retrospective analysis of 2002-2009 Medicare healthcare claims (5% random sample). Patients were ≥65 years old and survived ≥1 year without recurrent MI after MI hospitalization. Mortality, incidence of hospitalizations for stroke, major bleeding, MI, a composite endpoint (death, MI, or stroke), and nonpharmacy healthcare costs were determined. RESULTS Eligible patients included 16 244 STEMI, 34 576 NSTEMI, and 3109 unspecified MI. NSTEMI and unspecified MI patients had significantly higher prevalence of comorbidities than STEMI patients, except for hypertension and dyslipidemia. MI incidence declined 36% over the follow-up (3.82/100 person-years [PY] to 2.45/100 PY). Mortality, stroke, and bleeding decreased until the third year of follow-up and then increased. NSTEMI and unspecified MI patients had a significantly higher incidence of death, MI, the composite, and bleeding than STEMI patients throughout follow-up. All-cause inpatient costs during follow-up were 2.6- and 1.9-fold higher than baseline for STEMI and NSTEMI, respectively; cardiovascular-related inpatient costs were 3.5- and 2.2-fold higher, respectively. CONCLUSIONS Risks of mortality and cardiovascular events remain high in a Medicare population surviving >1 year after a MI. Continuing healthcare costs are doubled over pre-MI levels up to 5 years after an MI. Secondary prevention measures beyond the acute post-MI period may be indicated to reduce risk and cost in this chronic disease phase.
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Affiliation(s)
| | | | | | | | - Elizabeth Magnuson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Estimating cardiovascular disease incidence from prevalence: a spreadsheet based model. BMC Med Res Methodol 2017; 17:9. [PMID: 28114890 PMCID: PMC5259888 DOI: 10.1186/s12874-016-0288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background Disease incidence and prevalence are both core indicators of population health. Incidence is generally not as readily accessible as prevalence. Cohort studies and electronic health record systems are two major way to estimate disease incidence. The former is time-consuming and expensive; the latter is not available in most developing countries. Alternatively, mathematical models could be used to estimate disease incidence from prevalence. Methods We proposed and validated a method to estimate the age-standardized incidence of cardiovascular disease (CVD), with prevalence data from successive surveys and mortality data from empirical studies. Hallett’s method designed for estimating HIV infections in Africa was modified to estimate the incidence of myocardial infarction (MI) in the U.S. population and incidence of heart disease in the Canadian population. Results Model-derived estimates were in close agreement with observed incidence from cohort studies and population surveillance systems. This method correctly captured the trend in incidence given sufficient waves of cross-sectional surveys. The estimated MI declining rate in the U.S. population was in accordance with the literature. This method was superior to closed cohort, in terms of the estimating trend of population cardiovascular disease incidence. Conclusion It is possible to estimate CVD incidence accurately at the population level from cross-sectional prevalence data. This method has the potential to be used for age- and sex- specific incidence estimates, or to be expanded to other chronic conditions.
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Joynt KE, Chatterjee P, Orav EJ, Jha AK. Hospital closures had no measurable impact on local hospitalization rates or mortality rates, 2003-11. Health Aff (Millwood) 2016; 34:765-72. [PMID: 25941277 DOI: 10.1377/hlthaff.2014.1352] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act (ACA) set in motion payment changes that could put pressure on hospital finances and lead some hospitals to close. Understanding the impact of closures on patient care and outcomes is critically important. We identified 195 hospital closures in the United States between 2003 and 2011. We found no significant difference between the change in annual mortality rates for patients living in hospital service areas (HSAs) that experienced one or more closures and the change in rates in matched HSAs without a closure (5.5 percent to 5.2 percent versus 5.4 percent to 5.4 percent, respectively). Nor was there a significant difference in the change in all-cause mortality rates following hospitalization (9.1 percent to 8.2 percent in HSAs with a closure versus 9.0 percent to 8.4 percent in those without a closure). HSAs with a closure had a drop in readmission rates compared to controls (19.4 percent to 18.2 percent versus 18.8 percent to 18.3 percent). Overall, we found no evidence that hospital closures were associated with worse outcomes for patients living in those communities. These findings may offer reassurance to policy makers and clinical leaders concerned about the potential acceleration of hospital closures as a result of health care reform.
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Affiliation(s)
- Karen E Joynt
- Karen E. Joynt is an assistant professor in the Division of Cardiovascular Medicine, Harvard Medical School and Brigham and Women's Hospital, and an instructor at the Harvard T.H. Chan School of Public Health in the Department of Health Policy and Management, both in Boston, Massachusetts. She is currently serving as a senior adviser to the deputy assistant secretary for health policy in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, in Washington, D.C
| | - Paula Chatterjee
- Paula Chatterjee is a resident in medicine at Brigham and Women's Hospital
| | - E John Orav
- E. John Orav is an associate professor of medicine (biostatistics) at Harvard Medical School and Brigham and Women's Hospital and an associate professor of biostatistics at the Harvard T.H. Chan School of Public Health
| | - Ashish K Jha
- Ashish K. Jha is the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health
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Vin-Raviv N, Akinyemiju T, Meng Q, Sakhuja S, Hayward R. Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database. Cancer Med 2016; 6:320-329. [PMID: 27891823 PMCID: PMC5269570 DOI: 10.1002/cam4.968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022] Open
Abstract
The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. A total of 387,608 current marijuana users were identified based on ICD‐9 codes for marijuana use among hospitalized patients in the Nationwide Inpatient Sample database between 2007 and 2011. Logistic regression analysis was performed to determine the association between marijuana use and heart failure, cardiac disease, stroke, and in‐hospital mortality. All models were adjusted for age, gender, race, residential income, insurance, residential region, pain, and number of comorbidities. Among hospitalized patients, marijuana use was associated with a 60% increased odds of stroke (OR: 1.60, 95% CI: 1.44–1.77) compared with non‐users, but significantly reduced odds of heart failure (OR: 0.78, 95% CI: 0.75–0.82), cardiac disease (OR: 0.86, 95% CI: 0.82–0.91), or in‐hospital mortality (OR: 0.41, 95% CI: 0.38–0.44). Among cancer patients, odds of in‐hospital mortality was significantly reduced among marijuana users compared with non‐users (OR: 0.44, 95% CI: 0.35–0.55). Hospitalized marijuana users were more likely to experience a stroke compared with non‐users, but less likely to experience in‐hospital mortality. Prospective studies will be needed to better characterize the health effects of marijuana use, especially among older, sicker, and/or hospitalized patients. In the meantime, conversations regarding marijuana use/misuse may be warranted in the clinical setting in order for patients and healthcare providers to adequately weigh the anticipated benefits of marijuana use with potentially significant health risks.
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Affiliation(s)
- Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado.,School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama School of Public Health, Birmingham, Alabama
| | - Qingrui Meng
- Department of Biostatistics, University of Alabama School of Public Health, Birmingham, Alabama
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama
| | - Reid Hayward
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado.,School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado
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Chakkalakal RJ, Fox JP, Green JC, Nunez-Smith M, Nallamothu BK, Hasnain-Wynia R. Hospitalization Rates for Acute Myocardial Infarction Among Asian-American Subgroups: Have We Been Underestimating the Problem? J Immigr Minor Health 2016; 20:20-25. [PMID: 27757693 DOI: 10.1007/s10903-016-0517-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Concerns about the quality of race/ethnicity data collected by hospitals have limited our understanding of healthcare disparities affecting ethnic minorities in the United States. Using data from the New Jersey State Inpatient Databases and the American Community Survey, we calculated age-adjusted AMI hospitalization rates for Asian-American subgroups before (2005-2006) and after (2008-2009) New Jersey hospitals implemented standardized practices to collect more accurate granular race/ethnicity data from patients. Rates were reported per 100,000 persons for Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese subgroups. AMI hospitalization rates increased for all subgroups except Vietnamese following implementation of the New Jersey program; increases were statistically significant for Asian Indian, Chinese, and Korean subgroups. Rates of hospitalization for AMI increased significantly for multiple Asian-American subgroups following implementation of the New Jersey program. National population health metrics for Asian-American subgroups may be prone to significant underestimation without widespread utilization of similar practices.
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Affiliation(s)
- Rosette J Chakkalakal
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, 6000 Medical Center East, NT, Nashville, TN, 37232-8300, USA.
| | - Justin P Fox
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeremy C Green
- Department of Health Management and Policy, Saint Louis University, St. Louis, MO, USA
| | - Marcella Nunez-Smith
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine and Center for Health Outcomes and Policy, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:256. [PMID: 27500157 DOI: 10.21037/atm.2016.06.33] [Citation(s) in RCA: 635] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement.
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Affiliation(s)
| | - Carme Perez-Quilis
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | - Roman Leischik
- Faculty of Health, School of Medicine, University Witten/Herdecke, Hagen, Germany
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain;; European University of Madrid, Madrid, Spain
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Husaini BA, Levine RS, Norris KC, Cain V, Bazargan M, Moonis M. Heart Failure Hospitalization by Race/Ethnicity, Gender and Age in California: Implications for Prevention. Ethn Dis 2016; 26:345-54. [PMID: 27440974 PMCID: PMC4948801 DOI: 10.18865/ed.26.3.345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We examined variation in rates of hospitalization, risk factors, and costs by race/ethnicity, gender and age among heart failure (HF) patients. METHODS We analyzed California hospital discharge data for patients in 2007 (n=58,544) and 2010 (n=57,219) with a primary diagnosis of HF (ICD-9 codes: 402, 404, 428). HF cases included African Americans (Blacks; 14%), Hispanic/Latinos (21%), and non-Hispanic Whites (65%). Age-adjusted prevalence rates per 100,000 US population were computed per CDC methodology. RESULTS Four major trends emerged: 1) Overall HF rates declined by 7.7% from 284.7 in 2007 to 262.8 in 2010; despite the decline, the rates for males and Blacks remained higher compared with others in both years; 2) while rates for Blacks (aged ≤54) were 6 times higher compared with same age Whites, rates for Hispanics were higher than Whites in the middle age category; 3) risk factors for HF included hypertension, chronic heart disease, chronic kidney disease, atrial fibrillation, and chronic obstructive pulmonary disease; and 4) submitted hospitalization costs were higher for males, Blacks, and younger patients compared with other groups. CONCLUSIONS Health inequality in HF persists as hospitalization rates for Blacks remain higher compared with Whites and Hispanics. These findings reinforce the need to determine whether increased access to providers, or implementing proven hypertension and diabetes preventive programs among minorities might reduce subsequent hospitalization for HF in these populations.
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Affiliation(s)
- Baqar A. Husaini
- Center for Prevention Research, Tennessee State University, Nashville, TN
| | | | | | - Van Cain
- Center for Prevention Research, Tennessee State University, Nashville, TN
| | - Mohsen Bazargan
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Majaz Moonis
- University of Massachusetts Medical School, Worcester, MA
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Abstract
Cardiovascular disease (CVD) remains the leading cause of death in the developed countries and is estimated to be the leading cause of death in the developing countries by the year 2030. The cause for this rise in CVD is the increase in the major CVD risk factors (CVRFs) like hypertension, obesity, diabetes, and hyperlipidemia, which account for 80 % of all CVD deaths worldwide. In order to prevent the increase in CVD, it has been proposed to develop a low-cost polypill containing four to five generic drugs with known effectiveness in the reduction of the CVRFs. This polypill has now been tested in several recent studies for the primary and secondary prevention of CVD and stroke with fairly good results. A Medline search of the English language literature between 2011 and 2015 resulted in the identification of 15 studies with pertinent findings. These findings together with collateral literature will be discussed in this review.
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Wang Y, Eldridge N, Metersky ML, Sonnenfeld N, Fine JM, Pandolfi MM, Eckenrode S, Bakullari A, Galusha DH, Jaser L, Verzier NR, Nuti SV, Hunt D, Normand SLT, Krumholz HM. Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction. J Am Heart Assoc 2016; 5:JAHA.116.003731. [PMID: 27405808 PMCID: PMC5015406 DOI: 10.1161/jaha.116.003731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30‐day mortality and unplanned readmission rates for Medicare fee‐for‐service patients hospitalized for acute myocardial infarction (AMI). Methods and Results Using 2009–2013 medical record‐abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed‐effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital‐specific risk‐standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital‐specific 30‐day all‐cause risk‐standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk‐standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79–8.94) and 3.44% points (95% CI, 0.19–6.68) for the risk‐standardized mortality and unplanned readmission rates, respectively. Conclusions For Medicare fee‐for‐service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30‐day all‐cause mortality and on unplanned readmissions.
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Affiliation(s)
- Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Noel Eldridge
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD
| | - Mark L Metersky
- Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Nancy Sonnenfeld
- Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Rockville, MD
| | - Jonathan M Fine
- Section of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT
| | | | | | | | - Deron H Galusha
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lisa Jaser
- Department of Pharmacy, Griffin Hospital, Derby, CT
| | | | - Sudhakar V Nuti
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - David Hunt
- Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, Rockville, MD
| | - Sharon-Lise T Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Department of Health Policy and Management, Yale School of Public Health, New Haven, CT Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
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Sjoding MW, Prescott HC, Wunsch H, Iwashyna TJ, Cooke CR. Longitudinal Changes in ICU Admissions Among Elderly Patients in the United States. Crit Care Med 2016; 44:1353-60. [PMID: 26968023 PMCID: PMC4911310 DOI: 10.1097/ccm.0000000000001664] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Changes in population demographics and comorbid illness prevalence, improvements in medical care, and shifts in care delivery may be driving changes in the composition of patients admitted to the ICU. We sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. DESIGN Retrospective cohort study. SETTING U.S. hospitals. PATIENTS There were 27.8 million elderly (age, > 64 yr) fee-for-service Medicare beneficiaries hospitalized with an intensive care or coronary care room and board charge from 1996 to 2010. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We aggregated primary International Classification of Diseases, 9th Revision, Clinical Modification discharge diagnosis codes into diagnoses and disease categories. We examined trends in demographics, primary diagnosis, and outcomes among patients with critical care stays. Between 1996 and 2010, we found significant declines in patients with a primary diagnosis of cardiovascular disease, including coronary artery disease (26.6 to 12.6% of admissions) and congestive heart failure (8.5 to 5.4% of admissions). Patients with infectious diseases increased from 8.8% to 17.2% of admissions, and explicitly labeled sepsis moved from the 11th-ranked diagnosis in 1996 to the top-ranked primary discharge diagnosis in 2010. Crude in-hospital mortality rose (11.3 to 12.0%), whereas discharge destinations among survivors shifted, with an increase in discharges to hospice and postacute care facilities. CONCLUSIONS Primary diagnoses of patients admitted to critical care units have substantially changed over 15 years. Funding agencies, physician accreditation groups, and quality improvement initiatives should ensure that their efforts account for the shifting epidemiology of critical illness.
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Affiliation(s)
- Michael W Sjoding
- 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI. 2Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. 3VA Center for Clinical Management Research, Ann Arbor, MI. 4Department of Critical Care medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 5Division of Critical Care Medicine, Department of Anesthesia and Interdisciplinary, University of Toronto, Toronto, ON, Canada. 6Institute for Social Research, Ann Arbor, MI. 7Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Hatlen G, Romundstad S, Salvesen Ø, Dalen H, Hallan SI. Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events. Nephron Clin Pract 2016; 133:44-52. [DOI: 10.1159/000445856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/30/2016] [Indexed: 11/19/2022] Open
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Li S, Fonarow GC, Mukamal KJ, Liang L, Schulte PJ, Smith EE, DeVore A, Hernandez AF, Peterson ED, Bhatt DL. Sex and Race/Ethnicity–Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circ Cardiovasc Qual Outcomes 2016; 9:S36-44. [DOI: 10.1161/circoutcomes.115.002621] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zhang Q, Zhao D, Xie W, Xie X, Guo M, Wang M, Wang W, Liu W, Liu J. Recent Trends in Hospitalization for Acute Myocardial Infarction in Beijing: Increasing Overall Burden and a Transition From ST-Segment Elevation to Non-ST-Segment Elevation Myocardial Infarction in a Population-Based Study. Medicine (Baltimore) 2016; 95:e2677. [PMID: 26844503 PMCID: PMC4748920 DOI: 10.1097/md.0000000000002677] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Comparable data on trends of hospitalization rates for ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) remain unavailable in representative Asian populations.To examine the temporal trends of hospitalization for acute myocardial infarction (AMI) and its subtypes in Beijing.Patients hospitalized for AMI in Beijing from January 1, 2007 to December 31, 2012 were identified from the validated Hospital Discharge Information System. Trends in hospitalization rates, in-hospital mortality, length of stay (LOS), and hospitalization costs were analyzed by regression models for total AMI and for STEMI and NSTEMI separately. In total, 77,943 patients were admitted for AMI in Beijing during the 6 years, among whom 67.5% were males and 62.4% had STEMI. During the period, the rate of AMI hospitalization per 100,000 population increased by 31.2% (from 55.8 to 73.3 per 100,000 population) after age standardization, with a slight decrease in STEMI but a 3-fold increase in NSTEMI. The ratio of STEMI to NSTEMI decreased dramatically from 6.5:1.0 to 1.3:1.0. The age-standardized in-hospital mortality decreased from 11.2% to 8.6%, with a significant decreasing trend evident for STEMI in males and females (P < 0.001) and for NSTEMI in males (P = 0.02). The rate of percutaneous coronary intervention increased from 28.7% to 55.6% among STEMI patients. The total cost for AMI hospitalization increased by 56.8% after adjusting for inflation, although the LOS decreased by 1 day.The hospitalization burden for AMI has been increasing in Beijing with a transition from STEMI to NSTEMI. Diverse temporal trends in AMI subtypes from the unselected "real-world" data in Beijing may help to guide the management of AMI in China and other developing countries.
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Affiliation(s)
- Qian Zhang
- From the Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases (QZ, DZ, WX, MW, WW, JL), and Beijing Public Health Information Center, Beijing, China (XX, MG, WL)
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 742] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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Chen R, Strait KM, Dharmarajan K, Li SX, Ranasinghe I, Martin J, Fazel R, Masoudi FA, Cooke CR, Nallamothu BK, Krumholz HM. Hospital variation in admission to intensive care units for patients with acute myocardial infarction. Am Heart J 2015; 170:1161-9. [PMID: 26678638 PMCID: PMC5459386 DOI: 10.1016/j.ahj.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/01/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The treatment for patients with acute myocardial infarction (AMI) was transformed by the introduction of intensive care units (ICUs), yet we know little about how contemporary hospitals use this resource-intensive setting and whether higher use is associated with better outcomes. METHODS We identified 114,136 adult hospitalizations for AMI from 307 hospitals in the 2009 to 2010 Premier database using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Hospitals were stratified into quartiles by rates of ICU admission for AMI patients. Across quartiles, we examined in-hospital risk-standardized mortality rates and usage rates of critical care therapies for these patients. RESULTS Rates of ICU admission for AMI patients varied markedly among hospitals (median 48%, Q1-Q4 20%-71%, range 0%-98%), and there was no association with in-hospital risk-standardized mortality rates (6% all quartiles, P = .7). However, hospitals admitting more AMI patients to the ICU were more likely to use critical care therapies overall (mechanical ventilation [from Q1 with lowest rate of ICU use to Q4 with highest rate 13%-16%], vasopressors/inotropes [17%-21%], intra-aortic balloon pumps [4%-7%], and pulmonary artery catheters [4%-5%]; P for trend < .05 in all comparisons). CONCLUSIONS Rates of ICU admission for patients with AMI vary substantially across hospitals and were not associated with differences in mortality, but were associated with greater use of critical care therapies. These findings suggest uncertainty about the appropriate use of this resource-intensive setting and a need to optimize ICU triage for patients who will truly benefit.
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Affiliation(s)
- RuiJun Chen
- University of California San Francisco, San Francisco, CA
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Kumar Dharmarajan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | | | | | - Reza Fazel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Colin R Cooke
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Brahmajee K Nallamothu
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Veterans Affairs (VA) Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
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Sacks NC, Ash AS, Ghosh K, Rosen AK, Wong JB, Rosen AB. Trends in acute myocardial infarction hospitalizations: Are we seeing the whole picture? Am Heart J 2015; 170:1211-9. [PMID: 26678643 DOI: 10.1016/j.ahj.2015.09.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Payers and policy makers rely on studies of trends in acute myocardial infarction (AMI) hospitalizations and spending that count only hospitalizations where the AMI is the principal discharge diagnosis. Hospitalizations with AMI coded as a secondary diagnosis are ignored. The effects of excluding these hospitalizations on estimates of trends are unknown. METHODS Observational study of all AMI hospitalizations in Fee-for-Service Medicare beneficiaries 65 years and older, from 2002 through 2011. RESULTS We studied 3,663,137 hospitalizations with any AMI discharge diagnosis over 288,873,509 beneficiary-years. Of these, 66% had AMI coded as principal (versus secondary). From 2002 to 2011, AMI hospitalization rates declined 24.5% (from 1,485 per 100,000 beneficiary-years in 2002 to 1,122 in 2011). Meanwhile, the proportion of these hospitalizations with a secondary AMI diagnosis increased from 28% to 40%; by 2011 these secondary AMI hospitalizations accounted for 43% of all expenditures for hospitalizations with AMI, or $2.8 billion. Major changes in comorbidities, principal diagnoses and mean costs for hospitalizations with a non-principal AMI diagnosis occurred in the 2006-2008 timeframe. CONCLUSIONS Current estimates of the burden of AMI ignore an increasingly large proportion of overall AMI hospitalizations and spending. Changes in the characteristics of hospitalizations that coincided with major payment and policy changes suggest that non-clinical factors affect AMI coding. Failing to consider all AMIs could inflate estimates of population health improvements, overestimate the value of AMI prevention and treatment and underestimate current and future AMI burden and expenditures.
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