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Bonekamp NE, Visseren FLJ, Cramer MJ, Dorresteijn JAN, van der Meer MG, Ruigrok YM, van Sloten TT, Teraa M, Geleijnse JM, Koopal C. Long-term lifestyle change and risk of mortality and Type 2 diabetes in patients with cardiovascular disease. Eur J Prev Cardiol 2024; 31:205-213. [PMID: 37774501 DOI: 10.1093/eurjpc/zwad316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
AIMS To quantify the relationship between self-reported, long-term lifestyle changes (smoking, waist circumference, physical activity, and alcohol consumption) and clinical outcomes in patients with established cardiovascular disease (CVD). METHODS AND RESULTS Data were used from 2011 participants (78% male, age 57 ± 9 years) from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort who returned for a re-assessment visit (SMART2) after ∼10 years. Self-reported lifestyle change was classified as persistently healthy, improved, worsened, or persistently unhealthy. Cox proportional hazard models were used to quantify the relationship between lifestyle changes and the risk of (cardiovascular) mortality and incident Type 2 diabetes (T2D). Fifty-seven per cent of participants was persistently healthy, 17% improved their lifestyle, 8% worsened, and 17% was persistently unhealthy. During a median follow-up time of 6.1 (inter-quartile range 3.6-9.6) years after the SMART2 visit, 285 deaths occurred, and 99 new T2D diagnoses were made. Compared with a persistently unhealthy lifestyle, individuals who maintained a healthy lifestyle had a lower risk of all-cause mortality [hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.36-0.63], cardiovascular mortality (HR 0.57, 95% CI 0.38-0.87), and incident T2D (HR 0.46, 95% CI 0.28-0.73). Similarly, those who improved their lifestyle had a lower risk of all-cause mortality (HR 0.52, 95% CI 0.37-0.74), cardiovascular mortality (HR 0.46, 95% CI 0.26-0.81), and incident T2D (HR 0.50, 95% CI 0.27-0.92). CONCLUSION These findings suggest that maintaining or adopting a healthy lifestyle can significantly lower mortality and incident T2D risk in CVD patients. This study emphasizes the importance of ongoing lifestyle optimization in CVD patients, highlighting the potential for positive change regardless of previous lifestyle habits.
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Affiliation(s)
- Nadia E Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
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Fácila Rubio L, Lozano-Granero C, Vidal-Pérez R, Barrios V, Freixa-Pamias R. New technologies for the diagnosis, treatment, and monitoring of cardiovascular diseases. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:88-96. [PMID: 37838182 DOI: 10.1016/j.rec.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 10/16/2023]
Abstract
Telemedicine enables the remote provision of medical care through information and communication technologies, facilitating data transmission, patient participation, promotion of heart-healthy habits, diagnosis, early detection of acute decompensation, and monitoring and follow-up of cardiovascular diseases. Wearable devices have multiple clinical applications, ranging from arrhythmia detection to remote monitoring of chronic diseases and risk factors. Integrating these technologies safely and effectively into routine clinical practice will require a multidisciplinary approach. Technological advances and data management will increase telemonitoring strategies, which will allow greater accessibility and equity, as well as more efficient and accurate patient care. However, there are still unresolved issues, such as identifying the most appropriate technological infrastructure, integrating these data into medical records, and addressing the digital divide, which can hamper patients' adoption of remote care. This article provides an updated overview of digital tools for a more comprehensive approach to atrial fibrillation, heart failure, risk factors, and treatment adherence.
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Affiliation(s)
- Lorenzo Fácila Rubio
- Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Universitat de València, Valencia, Spain.
| | - Cristina Lozano-Granero
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal y Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael Vidal-Pérez
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (UAH), Madrid, Spain
| | - Román Freixa-Pamias
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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Mahendiran T, Hoepli A, Foster-Witassek F, Rickli H, Roffi M, Eberli F, Pedrazzini G, Jeger R, Radovanovic D, Fournier S. Twenty-year trends in the prevalence of modifiable cardiovascular risk factors in young acute coronary syndrome patients hospitalized in Switzerland. Eur J Prev Cardiol 2023; 30:1504-1512. [PMID: 36929213 DOI: 10.1093/eurjpc/zwad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
AIMS Modifiable cardiovascular risk factors (RFs) play a key role in the development of coronary artery disease. We evaluated 20-year trends in RF prevalence among young adults hospitalized with acute coronary syndromes (ACS) in Switzerland. METHODS AND RESULTS Data were analysed from the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry from 2000 to 2019. Young patients were defined as those aged <50 years. Among 58 028 ACS admissions, 7073 (14.1%) were young (median 45.6 years, IQR 42.0-48.0), of which 91.6% had at least one modifiable RF and 59.0% had at least two RFs. Smoking was the most prevalent RF (71.4%), followed by dyslipidaemia (57.3%), hypertension (35.9%), obesity (21.7%), and diabetes (10.1%). Compared with older patients, young patients were more likely to be obese (21.7% vs. 17.4%, P < 0.001) and active smokers (71.4% vs. 33.9%, P < 0.001). Among young patients, between 2000 and 2019, there was a significant increase in the prevalence of hypertension from 29.0% to 51.3% and obesity from 21.2% to 27.1% (both Ptrend < 0.001) but a significant decrease in active smoking from 72.5% to 62.5% (Ptrend = 0.02). There were no significant changes in the prevalence of diabetes (Ptrend = 0.32) or dyslipidaemia (Ptrend = 0.067). CONCLUSION Young ACS patients in Switzerland exhibit a high prevalence of RFs and are more likely than older patients to be obese and smokers. Between 2000 and 2019, RF prevalence either increased or remained stable, except for smoking which decreased but still affected approximately two-thirds of young patients in 2019. Public health initiatives targeting RFs in young adults in Switzerland are warranted.
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Affiliation(s)
- Thabo Mahendiran
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland
| | - André Hoepli
- AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fabienne Foster-Witassek
- AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Franz Eberli
- Department of Cardiology, Stadtspital Zurich, Zurich, Switzerland
| | | | - Raban Jeger
- Department of Cardiology, Stadtspital Zurich, Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland
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Cordero A, Dalmau González-Gallarza R, Masana L, Fuster V, Castellano JM, Ruiz Olivar JE, Zsolt I, Sicras-Mainar A, González Juanatey JR. Economic Burden Associated with the Treatment with a Cardiovascular Polypill in Secondary Prevention in Spain: Cost-Effectiveness Results of the NEPTUNO Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:559-571. [PMID: 37489131 PMCID: PMC10363366 DOI: 10.2147/ceor.s396290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/23/2023] [Indexed: 07/26/2023] Open
Abstract
Purpose The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain. Patients and Methods An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated. Results After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments. Conclusion CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.
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Affiliation(s)
- Alberto Cordero
- Cardiology Service, San Juan University Hospital, Alicante, Spain
- Cardiovascular Diseases Network Research Center (CIBERCV), Madrid, Spain
| | | | - Lluis Masana
- Sant Joan University Hospital, Vascular Medicine and Metabolism Unit, Reus, Spain
- Pere Virgili Institute of Health Research (IISPV), Reus, Spain
- Center for Biomedical Research Network on Diabetes and Associated Metabolic Diseases (CIBERDEM), Reus, Spain
| | - Valentín Fuster
- National Center for Cardiovascular Research (CNIC), Carlos III Health Institute, Madrid, Spain
- Mount Sinai Medical Center, New York, NY, USA
| | - Jose Mª Castellano
- National Center for Cardiovascular Research (CNIC), Carlos III Health Institute, Madrid, Spain
- Integral Center for Cardiovascular Diseases (CIEC), Montepríncipe University Hospital, HM Hospitales Group, Madrid, Spain
- School of Medicine, CEU San Pablo University, Madrid, Spain
| | | | - Ilonka Zsolt
- Corporate Medical Affairs, Ferrer, Barcelona, Spain
| | | | - Jose Ramón González Juanatey
- Cardiovascular Diseases Network Research Center (CIBERCV), Madrid, Spain
- Cardiology Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, Spain
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Prosenz J, Stättermayer MS, Riedl F, Maieron A. Adherence to guidelines in patients with non-variceal upper gastrointestinal bleeding (UGIB) - results from a retrospective single tertiary center registry. Scand J Gastroenterol 2023; 58:856-862. [PMID: 36855301 DOI: 10.1080/00365521.2023.2183734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/12/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Guidelines for the management of upper gastrointestinal bleeding (UGIB) are regularly published, yet little is known concerning adherence to recommendations in practice. OBJECTIVES We aimed to assess adherence to European Society of Gastrointestinal Endoscopy (ESGE) recommendations in patients with non-variceal UGIB. MATERIALS AND METHODS All hospitalized patients with an esophagogastroduodenoscopy (EGD) performed due to suspected non-variceal UGIB at our department were included in a prospective registry. Data between 2018-2020 from this registry were retrospectively analyzed. Adherence to the 2015 ESGE bleeding and propofol sedation guidelines was assessed. Adherence to recommendations concerning preendoscopic (risk) evaluation, preendoscopic PPI, transfusion management, and endoscopic management of peptic ulcers was analyzed. RESULTS Among 1005 patients (mean age 70.4 years, 42.1% women) the most common bleeding etiologies were gastric or duodenal ulcers (16.8%), esophagitis/GERD (11.1%), and angiodysplasia (9.9%); mortality was 7.6%. Adherence to preendosopic risk evaluation was low, in 0% a Mallampati classification and in 37.5% an ASA scoring was documented. Preendoscopic PPI was started at 58.6%, and adherence to recommended transfusion management was >98%. Peptic ulcers were Forrest-graded in 72.8%. High-risk ulcers were treated appropriately in 77.9% and low-risk ulcers were not treated in 73.6%. Especially Forrest Ib ulcers were undertreated, with an adherence of 59.6%. Only 22/179 (12.3%) patients with peptic ulcers and early endoscopy were consistently managed according to ESGE recommendations. CONCLUSIONS Adherence to ESGE guidelines in patients with non-variceal UGIB is moderate to low, even at a tertiary university hospital. Strategies must be devised for guidelines to reach patients in everyday practice.
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Affiliation(s)
- Julian Prosenz
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
| | - Marie-Sophie Stättermayer
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Florian Riedl
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
| | - Andreas Maieron
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Internal Medicine 2, University Hospital St. Pölten, St. Pölten, Austria
- Research Programme for Medical Science, Paracelsus Medical University, Salzburg, Austria
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Fox JJ, Mauguen A, Ito K, Gupta D, Yu A, Schindler TH, Strauss HW, Schöder H. Long-Term Prognostic Value of 82Rb PET/CT-Determined Myocardial Perfusion and Flow Reserve in Cancer Patients. J Nucl Med 2023; 64:791-796. [PMID: 36604182 PMCID: PMC10152130 DOI: 10.2967/jnumed.122.264795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Myocardial flow reserve (MFR), derived from quantitative measurements of myocardial blood flow during PET imaging, provides prognostic information on patients with coronary artery disease (CAD), but it is not known if this also applies to cancer patients with a competing risk for mortality. Methods: To determine the prognostic value of MFR in patients with cancer, we designed a retrospective cohort study comprising 221 patients with known or suspected CAD (median age, 71 y; range, 41-92 y) enrolled between June 2009 and January 2011. Most patients were referred for perioperative risk assessment. Patients underwent measurement of myocardial blood flow at rest and during pharmacologic stress, using quantitative 82Rb PET imaging. They were divided into early-stage versus advanced-stage cancer groups based on cancer histopathology and clinical state and were further stratified by myocardial perfusion summed stress score, summed difference score, and calculated MFR. Overall survival (OS) was assessed using the Kaplan-Meier estimator, and Cox proportional-hazards regression helped identify independent predictors for OS. Results: During a follow-up of 85.6 mo, 120 deaths occurred. MFR, summed difference score, and cancer stage were significantly associated with OS. In the age-adjusted Cox hazard multivariable analysis, MFR and cancer stage remained independent prognostic factors. MFR combined with cancer stage enhanced OS discrimination. The groups had significantly different outcomes (P < 0.001), with 5-y OS of 88% (MFR ≥ 1.97 and early-stage), 53% (MFR < 1.97 and early-stage), 33% (MFR ≥ 1.97 and advanced-stage), and 13% (MFR < 1.97 and advanced-stage). Conclusion: Independent of cancer stage, MFR derived from quantitative PET was prognostic of OS in our cohort of cancer patients with known or suspected CAD. Combining these 2 parameters enhanced discrimination of OS, suggesting that MFR improves risk stratification and may serve as a treatment target to increase survival in cancer patients.
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Affiliation(s)
- Josef J Fox
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kimiteru Ito
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Alice Yu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - H William Strauss
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
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Virani SS, Aspry K, Dixon DL, Ferdinand KC, Heidenreich PA, Jackson EJ, Jacobson TA, McAlister JL, Neff DR, Gulati M, Ballantyne CM. The importance of low-density lipoprotein cholesterol measurement and control as performance measures: A joint Clinical Perspective from the National Lipid Association and the American Society for Preventive Cardiology. J Clin Lipidol 2023; 17:208-218. [PMID: 36965958 DOI: 10.1016/j.jacl.2023.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
Despite the established role of low-density lipoprotein cholesterol (LDL-C) as a major risk factor for cardiovascular disease (CVD), and the persistence of CVD as the leading cause of morbidity and mortality in the United States, national quality assurance metrics no longer include LDL-C measurement as a required performance metric. This clinical perspective reviews the history of LDL-C as a quality and performance metric and the events that led to its replacement. It also presents patient, healthcare provider, and health system rationales for re-establishing LDL-C measurement as a performance measure to improve cholesterol control in high-risk groups and to stem the rising tide of CVD morbidity and mortality, cardiovascular care disparities, and related healthcare costs.
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Affiliation(s)
- Salim S Virani
- Baylor College of Medicine, Houston, Texas, USA (Drs Virani, Ballantyne); Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA (Dr Virani); The Aga Khan University, Karachi, Pakistan (Dr Virani)
| | - Karen Aspry
- Lifespan Cardiovascular Institute, and Alpert Medical School, Brown University, Providence, Rhode Island, USA (Dr Aspry)
| | - Dave L Dixon
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA (Dr Dixon)
| | - Keith C Ferdinand
- Tulane University School of Medicine, New Orleans, Louisiana, USA (Dr Ferdinand)
| | | | | | - Terry A Jacobson
- Emory University School of Medicine, Atlanta, Georgia, USA (Dr Jacobson)
| | | | - David R Neff
- Michigan State University, College of Osteopathic Medicine, Department of Family and Community Medicine, East Lansing, Michigan, USA (Dr Neff)
| | - Martha Gulati
- Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA (Dr Gulati)
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Virani SS, Aspry K, Dixon DL, Ferdinand KC, Heidenreich PA, Jackson EJ, Jacobson TA, McAlister JL, Neff DR, Gulati M, Ballantyne CM. The importance of low-density lipoprotein cholesterol measurement and control as performance measures: A joint clinical perspective from the National Lipid Association and the American Society for Preventive Cardiology. Am J Prev Cardiol 2023; 13:100472. [PMID: 36970638 PMCID: PMC10037190 DOI: 10.1016/j.ajpc.2023.100472] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 03/02/2023] Open
Abstract
Despite the established role of low-density lipoprotein cholesterol (LDL-C) as a major risk factor for cardiovascular disease (CVD), and the persistence of CVD as the leading cause of morbidity and mortality in the United States, national quality assurance metrics no longer include LDL-C measurement as a required performance metric. This clinical perspective reviews the history of LDL-C as a quality and performance metric and the events that led to its replacement. It also presents patient, healthcare provider, and health system rationales for re-establishing LDL-C measurement as a performance measure to improve cholesterol control in high-risk groups and to stem the rising tide of CVD morbidity and mortality, cardiovascular care disparities, and related healthcare costs.
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9
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Wang W, Song L. Landscape of lipidomics in cardiovascular medicine from 2012 to 2021: A systematic bibliometric analysis and literature review. Medicine (Baltimore) 2022; 101:e32599. [PMID: 36596038 PMCID: PMC9803420 DOI: 10.1097/md.0000000000032599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Lipidomics has shaped our knowledge of how lipids play a central role in cardiovascular diseases (CVD), whereas there is a lack of a summary of existing research findings. This study performed a bibliometric analysis of lipidomics research in cardiovascular medicine to reveal the core countries, institutions, key researchers, important references, major journals, research hotspots and frontiers in this field. From 2012 to 2021, a total of 761 articles were obtained from the Web of Science Core Collection database. There is a steady increase of publications yearly. The United States and China are on the top of the list regarding article output. The institutions with the most publications were the Baker Heart and Diabetes Institute, the Chinese Academy of Sciences and Harvard Medical School. Peter J Meikle was both the most published and most co-cited author. The major journal in this field is Journal of lipid research. Keyword co-occurrence analysis indicated that coronary heart disease, mass spectrometry, risk, fatty acid, and insulin resistance have become hot topics in this field and keyword burst detection suggests that metabolomics, activation, liver, low density lipoprotein are the frontiers of research in recent years. Collectively, lipidomics in CVD is still in its infancy with a steady increase yearly. More in-depth studies in this area are warranted in the future.
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Affiliation(s)
- Wenting Wang
- Department of Cardiovascular Disease, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
- * Correspondence: Wenting Wang, Department of Cardiology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, 208 Huancheng East Road, Hangzhou 310003, China (e-mail: )
| | - Lei Song
- Beijing University of Chinese Medicine, Beijing, China
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10
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Hertz JT, Sakita FM, Kweka GL, Tarimo TG, Goli S, Prattipati S, Bettger JP, Thielman NM, Bloomfield GS. One-Year Outcomes and Factors Associated With Mortality Following Acute Myocardial Infarction in Northern Tanzania. Circ Cardiovasc Qual Outcomes 2022; 15:e008528. [PMID: 35300504 PMCID: PMC9018510 DOI: 10.1161/circoutcomes.121.008528] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about long-term outcomes and uptake of secondary preventative therapies following acute myocardial infarction (AMI) in sub-Saharan Africa. METHODS Consecutive patients presenting with AMI (as defined by the Fourth Universal Definition of AMI Criteria) to a northern Tanzanian referral hospital were enrolled in this prospective observational study. Follow-up surveys assessing mortality, medication use, and rehospitalization were administered at 3, 6, 9, and 12 months following initial presentation, by telephone or in person. Multivariate logistic regression was performed to identify baseline clinical and sociodemographic factors associated with one-year mortality. RESULTS Of 152 enrolled patients with AMI, 5 were lost to one-year follow-up (96.7% retention rate). Mortality rates were 34.9% (53 of 152 participants) during the initial hospitalization, 48.7% (73 of 150 patients) at 3 months, 52.7% (78 of 148 patients) at 6 months, 55.4% (82 of 148 patients) at 9 months, and 59.9% (88 of 147 patients) at one year. Of 59 patients surviving to one-year follow-up, 43 (72.9%) reported persistent anginal symptoms, 5 (8.5%) were taking an antiplatelet, 8 (13.6%) were taking an antihypertensive, 30 (50.8%) had been rehospitalized, and 7 (11.9%) had ever undergone cardiac catheterization. On multivariate analysis, one-year mortality was associated with lack of secondary education (odds ratio, 0.26 [95% CI, 0.11-0.58]; P=0.001), lower body mass index (odds ratio, 0.90 [95% CI, 0.82-0.98]; P=0.015), and higher initial troponin (odds ratio, 1.30 [95% CI, 1.05-1.80]; P=0.052). CONCLUSIONS In northern Tanzania, AMI is associated with high all-cause one-year mortality and use of evidence-based secondary preventative therapies among AMI survivors is low. Interventions are needed to improve AMI care and outcomes.
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Affiliation(s)
- Julian T Hertz
- Division of Emergency Medicine (J.T.H.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania (F.M.S.)
| | - Godfrey L Kweka
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
| | - Tumsifu G Tarimo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
| | - Sumana Goli
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Sainikitha Prattipati
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Janet P Bettger
- Department of Orthopaedic Surgery (J.P.B.), Duke University, Durham, NC
- Duke-Margolis Center for Health Policy, Duke University, Washington, District of Colombia (J.P.B.)
| | - Nathan M Thielman
- Department of Internal Medicine (N.M.T.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Gerald S Bloomfield
- Division of Cardiology (G.S.B.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute, Durham, NC (G.S.B.)
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11
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Vilela EM, Fontes-Carvalho R. Inflammation and ischemic heart disease: The next therapeutic target? Rev Port Cardiol 2021; 40:785-796. [PMID: 34857118 DOI: 10.1016/j.repce.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/16/2021] [Indexed: 12/13/2022] Open
Abstract
Inflammation plays an important role in several stages of the cardiovascular continuum. In recent decades a plethora of studies have provided new data highlighting the role of inflammation in atherogenesis and atherothrombosis in two-way interactions with various cardiovascular risk factors and further influencing these dynamic processes. The concept of targeting residual inflammatory risk among individuals with ischemic heart disease (IHD) is therefore gaining increasing attention. Recently, several landmark randomized controlled trials have assessed different pharmacological approaches that may mitigate this residual risk. The results of some of these studies, such as CANTOS with canakinumab and COLCOT and LoDoCo2 with colchicine, are promising and have provided data to support this concept. Moreover, though several aspects remain to be clarified, these trials have shown the potential of modulating inflammation as a new target to reduce the risk of cardiovascular events in secondary prevention patients. In the present review, we aim to present a pragmatic overview of the complex interplay between inflammation and IHD, and to critically appraise the current evidence on this issue while presenting future perspectives on this topic of pivotal contemporary interest.
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Affiliation(s)
- Eduardo M Vilela
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Cardiovascular Research Center (UniC), Faculty of Medicine, University of Porto, Porto, Portugal
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12
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Silva V, Matos Vilela E, Campos L, Miranda F, Torres S, João A, Teixeira M, Braga P, Fontes-Carvalho R. Suboptimal control of cardiovascular risk factors in myocardial infarction survivors in a cardiac rehabilitation program. Rev Port Cardiol 2021; 40:911-920. [PMID: 34922696 DOI: 10.1016/j.repce.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/10/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES As short-term mortality continues to decrease after myocardial infarction (MI), secondary prevention strategies attain increasing relevance. This study aimed at assessing the control of cardiovascular (CV) risk factors, including dyslipidemia, hypertension and diabetes, in a contemporary cohort of MI survivors who completed an exercise-based cardiac rehabilitation (EBCR) program. METHODS Observational, retrospective cohort study including patients admitted to a tertiary center with acute MI between November 2012 and April 2017, who completed a phase II EBCR program after discharge. Achievement of low-density lipoprotein (LD) cholesterol, blood pressure and HbA1c guideline recommended targets was assessed. Lipid profile parameters were assessed and compared at three time points (hospitalization, beginning and end of the program). RESULTS A total of 379 patients were included. Mean age was 58.8±10.6 years; 81% were male. Considering the European Society of Cardiology's guidelines on contemporary data collection, 61%, 87% and 71% achieved the recommended LDL cholesterol, blood pressure and HbA1c targets, respectively, at the end of the program. Combining all three risk factors, 42% achieved the recommended targets. High-sensitivity C-reactive protein decreased between the beginning and the end of the program [0.14 (0.08-0.29) mg/L to 0.12 (0.06-0.26) mg/L; p<0.001]. CONCLUSION Despite contemporary management strategies, including enrollment in a structured EBCR program, a substantial number of patients presented suboptimal control of CV risk factors. Considering the dyslipidemia, hypertension and diabetes results, less than half of the enrolled individuals achieved the recommended targets. These findings highlight a pivotal unmet need which could be particularly relevant in improving CV outcomes by enhancing secondary prevention profiles.
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Affiliation(s)
- Vasco Silva
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação e Desenvolvimento Cardiovascular (UniC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Eduardo Matos Vilela
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lilibeth Campos
- Departamento de Medicina Física e Reabilitação, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Fátima Miranda
- Departamento de Medicina Física e Reabilitação, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Susana Torres
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana João
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Madalena Teixeira
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação e Desenvolvimento Cardiovascular (UniC), Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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13
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Silva V, Matos Vilela E, Campos L, Miranda F, Torres S, João A, Teixeira M, Braga P, Fontes-Carvalho R. Suboptimal control of cardiovascular risk factors in myocardial infarction survivors in a cardiac rehabilitation program. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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Peng H, Sun Z, Di B, Ding X, Chen H, Li H. Contemporary impact of circadian symptom-onset patterns of acute ST-Segment elevation myocardial infarction on long-term outcomes after primary percutaneous coronary intervention. Ann Med 2021; 53:247-256. [PMID: 33349057 PMCID: PMC7877989 DOI: 10.1080/07853890.2020.1863457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Daytime variation with regard to onset time of ST-elevation myocardial infarction (STEMI) symptoms has been observed. Nevertheless, with the advanced medical therapy, it is not uncertainty if a similar circadian pattern of STEMI symptom onset occurs, as well as its possible impact on clinical outcomes. Few long-term data are available. We assess the impact of circadian symptom-onset patterns of STEMI on major adverse cardiovascular events (MACE) in more contemporary patients treated with primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS A total of 1099 consecutive STEMI patients undergoing PPCI ≤12h from symptom onset during 2013 to 2019 were classified into 4 groups by 6-h intervals according to time-of-day at symptom onset: night (0:00-5:59), morning (6:00-11:59), afternoon (12:00-17:59), and evening (18:00-23:59). Incidence of MACE including cardiovascular death and nonfatal MI during a median follow-up of 48 months was compared among the 4 groups. A morning peak of symptom onset of STEMI was detected during the period 06:00-11:59 (p < .001). Compared with other three 6-h intervals, the incidence of long-term MACE during night onset-time (18.8%, 10.1%, 10.7% and 12.4%, p = .020) was significant higher that was driven by more mortality (13.1%, 6.5%, 7.1%and 7.7%, p = .044). Night symptom-onset STEMI was independently associated with subsequent MACE (hazard ratio = 1.57, 95%CI: 1.09-2.27, p = .017) even after multivariable adjustment. CONCLUSIONS Circadian variation of STEMI symptom-onset with morning predominance still exists in contemporary practice. Night symptom-onset STEMI was independently associated with increased risk of MACE in Chinese patients treated with PPCI.
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Affiliation(s)
- Hui Peng
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Zhijun Sun
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Beibing Di
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China.,Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, P. R. China
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15
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Falter M, Scherrenberg M, Kindermans H, Kizilkilic S, Kaihara T, Dendale P. Willingness to participate in cardiac telerehabilitation: results from semi-structured interviews. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 3:67-76. [PMID: 36713992 PMCID: PMC9707914 DOI: 10.1093/ehjdh/ztab091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2023]
Abstract
Aims Cardiac rehabilitation (CR) is indicated in patients with cardiovascular disease but participation rates remain low. Telerehabilitation (TR) is often proposed as a solution. While many trials have investigated TR, few have studied participation rates in conventional CR non-participants. The aim of this study was to identify the percentage of patients that would be willing to participate in a TR programme to identify the main perceived barriers and facilitators for participating in TR. Methods and results Two groups of patients were recruited: CR non-participants and CR participants. Semi-structured interviews were conducted. Thirty non-participants and 30 participants were interviewed. Of CR non-participants, 33% would participate in TR and 10% would participate in a blended CR programme (combination of centre-based CR and TR). Of CR participants, 60% would participate in TR and 70% would be interested in a blended CR programme. Of those that would participate in TR, 44% would prefer centre-based CR, 33% would prefer a blended CR programme, and 11% would prefer a full TR programme. In both groups, the main facilitating aspect about TR was not needing transport and the main barrier was digital literacy. Conclusion For CR non-participants, TR will only partly solve the problem of low participation rates and blended programmes might not offer a solution. Cardiac rehabilitation participants are more prepared to participate in TR and blended CR. Digital literacy was in both groups mentioned as an important barrier, emphasizing the challenges for healthcare and local governments to keep educating all types of patients in digital literacy.
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Affiliation(s)
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium,Department of Cardiovascular research, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan gebouw D, Diepenbeek, BE3590 Hasselt, Belgium,Department of Cardiovascular research, Faculty of Medicine and Health Sciences, Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Hanne Kindermans
- Department of Cardiovascular research, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan gebouw D, Diepenbeek, BE3590 Hasselt, Belgium
| | - Sevda Kizilkilic
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Toshiki Kaihara
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium,Department of Cardiovascular research, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan gebouw D, Diepenbeek, BE3590 Hasselt, Belgium,Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2 Chome-16-1 Sugao, Miyamae Ward, Kawasaki, Kanagawa 216-8511 Kawasaki, Japan
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium,Department of Cardiovascular research, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan gebouw D, Diepenbeek, BE3590 Hasselt, Belgium
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16
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Lõiveke P, Marandi T, Ainla T, Fischer K, Eha J. Adherence to recommendations for secondary prevention medications after myocardial infarction in Estonia: comparison of real-world data from 2004 to 2005 and 2017 to 2018. BMC Cardiovasc Disord 2021; 21:505. [PMID: 34670499 PMCID: PMC8527758 DOI: 10.1186/s12872-021-02321-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background Relatively high rates of adherence to myocardial infarction (MI) secondary prevention medications have been reported, but register-based, objective real-world data is scarce. We aimed to analyse adherence to guideline-recommended medications for secondary prevention of MI in 2017 to 2018 (period II) and compare the results with data from 2004 to 2005 (period I) in Estonia.
Methods Study populations were formed based on data from the Estonian Health Insurance Fund’s database and on Estonian Myocardial Infarction Register. By linking to the Estonian Medical Prescription Centre database adherence to guideline-recommended medications for MI secondary prevention was assessed for 1 year follow-up period from the first hospitalization due to MI. Data was analysed using the defined daily dosages methodology. Results Total of 6694 and 6060 cases of MI were reported in periods I and II, respectively. At least one prescription during the follow up period was found for beta-blockers in 81.0% and 83.5% (p = 0.001), for angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEi/ARB) in 76.9% and 66.0% (p < 0.001), and for statins in 44.0% and 67.0% (p < 0.001) of patients in period I and II, respectively. P2Y12 inhibitors were used by 76.4% of patients in period II. The logistic regression analysis adjusted to gender and age revealed that some drugs and drug combinations were not allocated similarly in different age and gender groups. Conclusions In Estonia, adherence to MI secondary prevention guideline-recommended medications has improved. But as adherence is still not ideal more attention should be drawn to MI secondary prevention through systematic guideline implementation.
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Affiliation(s)
- Piret Lõiveke
- Department of Cardiology, University of Tartu, Tartu, Estonia. .,Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Str, 13419, Tallinn, Estonia.
| | - Toomas Marandi
- Department of Cardiology, University of Tartu, Tartu, Estonia.,Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Str, 13419, Tallinn, Estonia.,Quality Department, North Estonia Medical Centre, Tallinn, Estonia
| | - Tiia Ainla
- Department of Cardiology, University of Tartu, Tartu, Estonia.,Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Str, 13419, Tallinn, Estonia
| | - Krista Fischer
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaan Eha
- Department of Cardiology, University of Tartu, Tartu, Estonia.,Heart Clinic, Tartu University Hospital, Tartu, Estonia
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17
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Vilela EM, Fontes-Carvalho R. Inflammation and ischemic heart disease: The next therapeutic target? Rev Port Cardiol 2021; 40:S0870-2551(21)00321-8. [PMID: 34456098 DOI: 10.1016/j.repc.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/07/2021] [Accepted: 02/16/2021] [Indexed: 10/20/2022] Open
Abstract
Inflammation plays an important role in several stages of the cardiovascular continuum. In recent decades a plethora of studies have provided new data highlighting the role of inflammation in atherogenesis and atherothrombosis in two-way interactions with various cardiovascular risk factors and further influencing these dynamic processes. The concept of targeting residual inflammatory risk among individuals with ischemic heart disease (IHD) is therefore gaining increasing attention. Recently, several landmark randomized controlled trials have assessed different pharmacological approaches that may mitigate this residual risk. The results of some of these studies, such as CANTOS with canakinumab and COLCOT and LoDoCo2 with colchicine, are promising and have provided data to support this concept. Moreover, though several aspects remain to be clarified, these trials have shown the potential of modulating inflammation as a new target to reduce the risk of cardiovascular events in secondary prevention patients. In the present review, we aim to present a pragmatic overview of the complex interplay between inflammation and IHD, and to critically appraise the current evidence on this issue while presenting future perspectives on this topic of pivotal contemporary interest.
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Affiliation(s)
- Eduardo M Vilela
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Cardiovascular Research Center (UniC), Faculty of Medicine, University of Porto, Porto, Portugal
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18
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Goli S, Sakita FM, Kweka GL, Tarimo TG, Temu G, Thielman NM, Bettger JP, Bloomfield GS, Limkakeng AT, Hertz JT. Thirty-day outcomes and predictors of mortality following acute myocardial infarction in northern Tanzania: A prospective observational cohort study. Int J Cardiol 2021; 342:23-28. [PMID: 34364908 DOI: 10.1016/j.ijcard.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/28/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a rising burden of myocardial infarction (MI) within sub-Saharan Africa. Prospective studies of detailed MI outcomes in the region are lacking. METHODS Adult patients with confirmed MI from a prospective surveillance study in northern Tanzania were enrolled in a longitudinal cohort study after baseline health history, medication use, and sociodemographic data were obtained. Thirty days following hospital presentation, symptom status, rehospitalizations, medication use, and mortality were assessed via telephone or in-person interviews using a standardized follow-up questionnaire. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. RESULTS Thirty-day follow-up was achieved for 150 (98.7%) of 152 enrolled participants. Of these, 85 (56.7%) survived to thirty-day follow-up. Of the surviving participants, 71 (83.5%) reported persistent anginal symptoms, four (4.7%) reported taking aspirin regularly, seven (8.2%) were able to identify MI as the reason for their hospitalization, and 17 (20.0%) had unscheduled rehospitalizations. Self-reported history of diabetes at baseline (OR 0.32, 95% CI 0.10-0.89, p = 0.04), self-reported history of hypertension at baseline (OR 0.34, 95% CI 0.15-0.74, p = 0.01), and antiplatelet use at initial presentation (OR 0.19, 95% CI 0.04-0.65, p = 0.02) were all associated with lower odds of thirty-day mortality. CONCLUSIONS In northern Tanzania, thirty-day outcomes following acute MI are poor, and mortality is associated with self-awareness of comorbidities and medication usage. Further investigation is needed to develop interventions to improve care and outcomes of MI in Tanzania.
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Affiliation(s)
- Sumana Goli
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA.
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Godfrey L Kweka
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Tumsifu G Tarimo
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Nathan M Thielman
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Janet P Bettger
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Gerald S Bloomfield
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
| | | | - Julian T Hertz
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
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19
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Kamel H, Hafez MS, Bastawy I. Telemedicine Improves the Short-Term Medical Care of Acute ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:693731. [PMID: 34322529 PMCID: PMC8311002 DOI: 10.3389/fcvm.2021.693731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/09/2021] [Indexed: 01/27/2023] Open
Abstract
Objectives: Telemedicine appears to be a promising tool for healthcare professionals to deliver remote care to patients with cardiovascular diseases especially during the COVID-19 pandemic. We aimed in this study to evaluate the value of telemedicine added to the short-term medical care of acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Methods: Two hundred acute STEMI patients after primary PCI were randomly divided into two groups. One hundred patients in group A (study group) received a monthly videoconferencing teleconsultation using a smartphone application for 3 months starting 1 week after discharge and at least a single face-to-face (F2F) clinic visit. We reviewed in each virtual visit the symptoms of patients, adherence to healthy lifestyle measures, medications, smoking cessation, and cardiac rehabilitation. Group B (control group) included 100 patients who received at least a single F2F clinic visit in the first 3 months after discharge. Both groups were interviewed after 4 months from discharge for major adverse cardiac events (MACE), adherence to medications, smoking cessation, and cardiac rehabilitation. A survey was done to measure the satisfaction of patients with telemedicine. Results: There was no significant difference between both groups in MACE and their adherence to aspirin, P2Y12 inhibitor, and beta-blockers. However, group A patients had better adherence to statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, smoking cessation, and cardiac rehabilitation. Sixty-one percent of patients stated that these videoconferencing teleconsultations were as good as the clinic visits, while 87% of patients were satisfied with telemedicine. Conclusions: Telemedicine may provide additional benefit to the short-term regular care after primary PCI to STEMI patients through videoconferencing teleconsultations by increasing their adherence to medications and healthy lifestyle measures without a significant difference in the short-term MACE. These virtual visits gained a high level of satisfaction among the patients.
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Affiliation(s)
- Heba Kamel
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Saber Hafez
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Bastawy
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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20
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Holt A, Blanche P, Zareini B, Rajan D, El-Sheikh M, Schjerning AM, Schou M, Torp-Pedersen C, McGettigan P, Gislason GH, Lamberts M. Effect of long-term beta-blocker treatment following myocardial infarction among stable, optimally treated patients without heart failure in the reperfusion era: a Danish, nationwide cohort study. Eur Heart J 2021; 42:907-914. [PMID: 33428707 DOI: 10.1093/eurheartj/ehaa1058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed to investigate the long-term cardio-protective effect associated with beta-blocker (BB) treatment in stable, optimally treated myocardial infarction (MI) patients without heart failure (HF). METHODS AND RESULTS Using nationwide registries, we included patients with first-time MI undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during admission and treated with both acetyl-salicylic acid and statins post-discharge between 2003 and 2018. Patients with prior history of MI, prior BB use, or any alternative indication or contraindication for BB treatment were excluded. Follow-up began 3 months following discharge in patients alive, free of cardiovascular (CV) events or procedures. Primary outcomes were CV death, recurrent MI, and a composite outcome of CV events. We used adjusted logistic regression and reported standardized absolute risks and differences (ARD) 3 years after MI. Overall, 30 177 stable, optimally treated MI patients were included (58% acute PCI, 26% sub-acute PCI, 16% CAG without intervention). At baseline, 82% of patients were on BB treatment (median age 61 years, 75% male) and 18% were not (median age 62 years, 68% male). BB treatment was associated with a similar risk of CV death, recurrent MI, and the composite outcome of CV events compared with no BB treatment [ARD (95% confidence intervals)] correspondingly; 0.1% (-0.3% to 0.5%), 0.2% (-0.7% to 1.2%), and 1.2% (-0.2% to 2.7%). CONCLUSIONS In this nationwide cohort study of stable, optimally treated MI patients without HF, we found no long-term effect of BB treatment on CV prognosis following the patients from 3 months to 3 years after MI admission.
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Affiliation(s)
- Anders Holt
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark
| | - Paul Blanche
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark.,Department of Biostatistics, Copenhagen University, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark
| | - Bochra Zareini
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark
| | - Deepthi Rajan
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark
| | - Mohammed El-Sheikh
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark
| | - Anne-Marie Schjerning
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, DK-4000 Roskilde, Denmark
| | - Morten Schou
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, DK-9100 Aalborg, Denmark.,Department of Clinical investigation and Cardiology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
| | - Patricia McGettigan
- Department of Clinical Pharmacology, William Harvey Research Institute, Charterhouse Square Barts and the London School of Medicine and Dentistry Queen Mary University of London, London EC1M 6BQ, UK
| | - Gunnar H Gislason
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark.,Department of Research, Danish Heart Foundation, Vognmagergade 7, 3. sal DK-1120 Copenhagen, Denmark
| | - Morten Lamberts
- Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark
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21
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Shen J, Liu G, Yang Y, Li X, Zhu Y, Xiang Z, Gan H, Huang B, Luo S. Prognostic impact of mean heart rate by Holter monitoring on long-term outcome in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Clin Res Cardiol 2021; 110:1439-1449. [PMID: 33547959 DOI: 10.1007/s00392-021-01806-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have shown elevated admission heart rate (HR) was associated with worse outcome in patients with myocardial infarction (MI). However, the prognostic value of mean heart rate (MHR) with Holter monitoring remains unclear. OBJECTIVES Our present study aims to evaluate the impact of MHR by Holter monitoring on long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI). METHODS 1013 STEMI patients were divided into four groups according to the quartiles of MHR by Holter monitoring, Q1 (< 66 bpm), Q2 66-72 bpm), Q3 (73-78 bpm), and Q4 (> 78 bpm). The endpoint was long-term all-cause mortality. The predictive value of admission HR, discharge HR, and MHR was compared with receiver operating characteristic (ROC) curves. RESULTS Patients in Q4 were more likely to present with anterior MI, high Killip class, relatively lower admission blood pressure, significantly increased troponin I, B-type natriuretic peptide, and decreased left ventricular ejection fraction. During a median of 28.3 months follow up period, 91 patients (8.9%) died. The mortality in Q4 was significantly higher than in the other three groups (P < 0.001). After multivariate adjustment, Q4 was associated with a 1.0-fold increased risk of long-term all-cause mortality (HR = 2.096, 95% CI 1.190-3.691, P = 0.010). ROC analysis shows MHR with Holter (AUC = 0.672) was superior to admission HR (AUC = 0.556) or discharge HR (AUC = 0.578). CONCLUSIONS MHR based on Holter monitoring provided important prognostic value and MHR > 78 bpm was independently associated with increased risk of long-term all-cause mortality in patients with STEMI, and its predictive validity was superior to admission or discharge HR.
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Affiliation(s)
- Jian Shen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Gang Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Yuan Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Xiang Li
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Yuansong Zhu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Zhenxian Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Hongbo Gan
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
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22
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Falter M, Scherrenberg M, Dendale P. Digital Health in Cardiac Rehabilitation and Secondary Prevention: A Search for the Ideal Tool. SENSORS 2020; 21:s21010012. [PMID: 33374985 PMCID: PMC7792579 DOI: 10.3390/s21010012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
Digital health is becoming more integrated in daily medical practice. In cardiology, patient care is already moving from the hospital to the patients' homes, with large trials showing positive results in the field of telemonitoring via cardiac implantable electronic devices (CIEDs), monitoring of pulmonary artery pressure via implantable devices, telemonitoring via home-based non-invasive sensors, and screening for atrial fibrillation via smartphone and smartwatch technology. Cardiac rehabilitation and secondary prevention are modalities that could greatly benefit from digital health integration, as current compliance and cardiac rehabilitation participation rates are low and optimisation is urgently required. This viewpoint offers a perspective on current use of digital health technologies in cardiac rehabilitation, heart failure and secondary prevention. Important barriers which need to be addressed for implementation in medical practice are discussed. To conclude, a future ideal digital tool and integrated healthcare system are envisioned. To overcome personal, technological, and legal barriers, technological development should happen in dialog with patients and caregivers. Aided by digital technology, a future could be realised in which we are able to offer high-quality, affordable, personalised healthcare in a patient-centred way.
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Affiliation(s)
- Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (P.D.)
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- KU Leuven, Faculty of Medicine, 3000 Leuven, Belgium
- Correspondence:
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (P.D.)
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (P.D.)
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
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23
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Gaalema DE, Bolívar HA, Khadanga S, Priest JS, Higgins ST, Ades PA. Current smoking as a marker of a high-risk behavioral profile after myocardial infarction. Prev Med 2020; 140:106245. [PMID: 32910931 PMCID: PMC7680426 DOI: 10.1016/j.ypmed.2020.106245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
Continued smoking following myocardial infarction (MI) is strongly associated with increased morbidity and mortality. Patients who continue to smoke may also engage in other behaviors that exacerbate risk. This study sought to characterize the risk profile of a national sample of individuals with previous MI who currently smoke. Data were taken from the 2017 Behavioral Risk Factor Surveillance Survey (United States), with 4.2% of the sample reporting a past MI (N = 26,004). Participants were classified by smoking status (current/former/never) and compared on medical comorbidities and the clustering of modifiable behaviors relevant for secondary prevention (smoking, poor nutrition, problematic alcohol use, physical inactivity, medication adherence). Current smokers were more likely to report other comorbidities including stroke, chronic obstructive pulmonary disease, physical limitations, and poor mental health. Smokers were also less likely to report taking blood pressure and cholesterol medications, and less likely to attend cardiac rehabilitation (examined in a subset of the sample, N = 2181). Current smoking remained an independent predictor of other health-related behaviors even when controlling for age, sex, race, educational attainment, and other comorbidities. In the modifiable risk-factor behavior cluster analysis, the most common pattern among current smokers was having two risk factors, smoking plus one additional risk factor, whereas the most common pattern was zero risk factors among never or former-smokers. Physical inactivity was the most common additional risk factor across smoking statuses. Current smoking is associated with multiple comorbidities and should be considered a marker for a high-risk behavioral profile among patients with a history of MI.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States.
| | - Hypatia A Bolívar
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Sherrie Khadanga
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Burlington, VT, United States
| | - Jeffrey S Priest
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Philip A Ades
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Burlington, VT, United States
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24
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Narla A, Paruchuri K, Natarajan P. Digital health for primary prevention of cardiovascular disease: Promise to practice. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2020; 1:59-61. [PMID: 32984862 PMCID: PMC7501772 DOI: 10.1016/j.cvdhj.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Akhila Narla
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Boston, Massachusetts
| | - Kaavya Paruchuri
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Boston, Massachusetts
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Boston, Massachusetts
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25
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Solomon MD, Leong TK, Levin E, Rana JS, Jaffe MG, Sidney S, Sung SH, Lee C, DeMaria A, Go AS. Cumulative Adherence to Secondary Prevention Guidelines and Mortality After Acute Myocardial Infarction. J Am Heart Assoc 2020; 9:e014415. [PMID: 32131689 PMCID: PMC7335507 DOI: 10.1161/jaha.119.014415] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
Background The survival benefit associated with cumulative adherence to multiple clinical and lifestyle-related guideline recommendations for secondary prevention after acute myocardial infarction (AMI) is not well established. Methods and Results We examined adults with AMI (mean age 68 years; 64% men) surviving at least 30 (N=25 778) or 90 (N=24 200) days after discharge in a large integrated healthcare system in Northern California from 2008 to 2014. The association between all-cause death and adherence to 6 or 7 secondary prevention guideline recommendations including medical treatment (prescriptions for β-blockers, renin-angiotensin-aldosterone system inhibitors, lipid medications, and antiplatelet medications), risk factor control (blood pressure <140/90 mm Hg and low-density lipoprotein cholesterol <100 mg/dL), and lifestyle approaches (not smoking) at 30 or 90 days after AMI was evaluated with Cox proportional hazard models. To allow patients time to achieve low-density lipoprotein cholesterol <100 mg/dL, this metric was examined only among those alive 90 days after AMI. Overall guideline adherence was high (35% and 34% met 5 or 6 guidelines at 30 days; and 31% and 23% met 6 or 7 at 90 days, respectively). Greater guideline adherence was independently associated with lower mortality (hazard ratio, 0.57 [95% CI, 0.49-0.66] for those meeting 7 and hazard ratio, 0.69 [95% CI, 0.61-0.78] for those meeting 6 guidelines versus 0 to 3 guidelines in 90-day models, with similar results in the 30-day models), with significantly lower mortality per each additional guideline recommendation achieved. Conclusions In a large community-based population, cumulative adherence to guideline-recommended medical therapy, risk factor control, and lifestyle changes after AMI was associated with improved long-term survival. Full adherence was associated with the greatest survival benefit.
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Affiliation(s)
- Matthew D. Solomon
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
- Division of CardiologyKaiser Permanente Oakland Medical CenterOaklandCA
| | - Thomas K. Leong
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Eleanor Levin
- Division of CardiologyKaiser Permanente Santa Clara Medical CenterSanta ClaraCA
| | - Jamal S. Rana
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
- Division of CardiologyKaiser Permanente Oakland Medical CenterOaklandCA
| | - Marc G. Jaffe
- Division of EndocrinologyKaiser
Permanente South San Francisco Medical CenterSan FranciscoCA
| | - Stephen Sidney
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Sue Hee Sung
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Catherine Lee
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Anthony DeMaria
- Division of CardiologyUniversity of California at San DiegoCA
| | - Alan S. Go
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
- Departments of Epidemiology, Biostatistics and MedicineUniversity of CaliforniaSan FranciscoCA
- Departments of Medicine, Health Research and PolicyStanford UniversityPalo AltoCA
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