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Wienbergen H, Fach A, Winzer EB, Schmucker J, Hanses U, Retzlaff T, Rühle S, Litfin C, Kerniss H, Marín LAM, Elsässer A, Gielen S, Eitel I, Linke A, Hambrecht R, Osteresch R. Impact of educational attainment on preventive efforts after myocardial infarction: results of the IPP and NET-IPP trials. Clin Res Cardiol 2023:10.1007/s00392-023-02285-2. [PMID: 37648751 DOI: 10.1007/s00392-023-02285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
AIMS Educational attainment might impact secondary prevention after myocardial infarction (MI). The purpose of the present study was to compare the rate of risk factors and the efficacy of an intensive prevention program (IPP), performed by prevention assistants and supervised by physicians, in patients with MI and different levels of education. METHODS In this post hoc analysis of the multicenter IPP and NET-IPP trials, patients with MI were stratified into two groups according to educational attainment: no "Abitur" (no A) vs. "Abitur" or university degree (AUD). The groups were compared at the time of index MI and after 12-month IPP vs. usual care. RESULTS Out of n = 462 patients with MI, 76.0% had no A and 24.0% had AUD. At the time of index, MI rates of obesity (OR 2.4; 95%CI 1.4-4.0), smoking (OR 2.2, 95%CI 1.4-3.6), and physical inactivity (OR 1.6; 95%CI 1.0-2.5) were significantly elevated in patients with no A. At 12 months after index MI, larger improvements of the risk factors smoking and physical inactivity were observed in patients with IPP and no A than in patients with IPP and AUD or with usual care. LDL cholesterol levels were reduced by IPP compared to usual care, with no difference between no A vs. AUD. A matched-pair analysis revealed that high baseline risk was an important reason for the large risk factor reductions in patients with IPP and no A. CONCLUSION The study demonstrates that patients with MI and lower educational level have an increased rate of lifestyle-related risk factors and a 12-month IPP, which is primarily performed by non-physician prevention assistants, is effective to improve prevention in this high-risk cohort.
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Affiliation(s)
- Harm Wienbergen
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany.
- Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
- Affiliated institute to the University of Lübeck, Senator-Weßling-Str. 2, 28277, Bremen, Germany.
| | - Andreas Fach
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Ephraim B Winzer
- Heart Center Dresden, University Hospital, Department for Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Johannes Schmucker
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Ulrich Hanses
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Tina Retzlaff
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Stephan Rühle
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Carina Litfin
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Hatim Kerniss
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | | | - Albrecht Elsässer
- University Clinic for Internal Medicine, Cardiology, Oldenburg, Germany
| | - Stephan Gielen
- Department of Cardiology, Angiology, and Intensive Care Medicine Klinikum Lippe, University Clinic Ostwestfalen-Lippe, Detmold, Germany
| | - Ingo Eitel
- Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Axel Linke
- Heart Center Dresden, University Hospital, Department for Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Rainer Hambrecht
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
| | - Rico Osteresch
- Bremen Institute for Heart and Circulation Research (BIHKF), Bremen, Germany
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Anand VV, Zhe ELC, Chin YH, Goh RSJ, Lin C, Kueh MTW, Chong B, Kong G, Tay PWL, Dalakoti M, Muthiah M, Dimitriadis GK, Wang JW, Mehta A, Foo R, Tse G, Figtree GA, Loh PH, Chan MY, Mamas MA, Chew NWS. Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices. Int J Cardiol 2023:S0167-5273(23)00597-1. [PMID: 37116760 DOI: 10.1016/j.ijcard.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/26/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Low socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. METHODS Medline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment. A comparative meta-analysis was conducted using random-effects models to estimate the risk ratio of all-cause mortality in low SES vs high SES populations, stratified according to geographical region, study year, follow-up duration and SES index. RESULTS A total of 29 studies comprising of 301,340 individuals were included, of whom 43.7% were classified as low SES. While patients of both SES groups had similar cardiovascular risk profiles, ACS patients of low SES had significantly higher risk of all-cause mortality (adjusted HR:1.19, 95%CI: 1.10-1.1.29, p < 0.001) compared to patients of high SES, with higher 1-year mortality (RR:1.08, 95%CI:1.03-1.13, p = 0.0057) but not 30-day mortality (RR:1.07, 95%CI:0.98-1.16, p = 0.1003). Despite having similar rates of ST-elevation myocardial infarction and non-ST-elevation ACS, individuals with low SES had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91-0.99, p = 0.0115) and had higher cerebrovascular accident risk (RR:1.25, 95%CI:1.01-1.55, p = 0.0469). Excess mortality risk was independent of region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p = 0.0604) but was dependent on the SES index used (p < 0.0001). CONCLUSION Low SES is associated with increased mortality post-ACS, with suboptimal coronary revascularisation rates compared to those of high SES. Concerted efforts are needed to address the global ACS-related socioeconomic inequity. REGISTRATION AND PROTOCOL The current study was registered with PROSPERO, ID: CRD42022334482.
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Affiliation(s)
- Vickram Vijay Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ethan Lee Cheng Zhe
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yip Han Chin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Chaoxing Lin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Martin Tze Wah Kueh
- Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Malaysia
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Phoebe Wen Lin Tay
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Mayank Dalakoti
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK; Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Jiong-Wei Wang
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Surgery, Cardiovascular Research Institute (CVRI), National University of Singapore, Singapore; Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anurag Mehta
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University Pauley Heart Centre, Richmond, VA, USA
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, Kent, Canterbury CT2 7NT, UK
| | - Gemma A Figtree
- Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Poay Huan Loh
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Institute of Population Health, University of Manchester, UK
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
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Wienbergen H, Hambrecht R. Stärkung der Prävention: von der Früherkennung bis zur qualifizierten Nachsorge. AKTUELLE KARDIOLOGIE 2023. [DOI: 10.1055/a-2001-6530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
ZusammenfassungAktuelle Versorgungsstudien zeigen eine alarmierende Zunahme lebensstilassoziierter kardiovaskulärer Risikofaktoren (wie Adipositas und körperliche Inaktivität) in der Bevölkerung; eine
Verstärkung dieser Entwicklung ist durch die Coronapandemie zu befürchten. Aufklärungsmaßnahmen (insbesondere in Bevölkerungsschichten mit niedrigem sozioökonomischen Status) sowie
konsequentes politische Handeln (z. B. beim Nichtraucherschutz oder bei der Steuerung von Ernährungsverhalten) sind deshalb von großer Wichtigkeit.Für die Risikostratifikation und Früherkennung von kardiovaskulären Erkrankungen bei einzelnen Personen empfehlen die aktuellen europäischen Leitlinien SCORE2 unter Beachtung von
Risikomodifikatoren (Bildgebung mit Karotis-Ultraschall oder Kardio-CT, psychosoziale und ethnische Faktoren, Begleiterkrankungen). Zukünftig werden voraussichtlich deutlich komplexere
Methoden der Risikostratifikation zur Verfügung stehen (insbesondere Genetik und künstliche Intelligenz), die aber derzeit noch nicht für den Routineeinsatz empfohlen werden.In der Nachsorge von Patienten mit manifesten Herz-Kreislauf-Erkrankungen besteht ein großer Verbesserungsbedarf zur nachhaltigen Einstellung der Risikofaktoren. Aktuelle Studien haben die
Effektivität von intensiven Langzeit-Präventions-Programmen nachgewiesen, die durch Präventions-Assistent*innen mit ärztlicher Supervision durchgeführt werden. Deshalb wurde im letzten Jahr
ein deutschlandweit standardisiertes Curriculum zur Ausbildung von kardiovaskulären Präventions-Assistent*innen eingeführt, die nun in der Praxis die präventivmedizinische Nachsorge der
Patienten*innen verbessern können.
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Wienbergen H, Boakye D, Günther K, Schmucker J, Mata Marín LA, Kerniss H, Nagrani R, Struß L, Rühle S, Retzlaff T, Fach A, Osteresch R, Hambrecht R, Ahrens W. Lifestyle and metabolic risk factors in patients with early-onset myocardial infarction: a case-control study. Eur J Prev Cardiol 2022; 29:2076-2087. [PMID: 35776839 DOI: 10.1093/eurjpc/zwac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 01/11/2023]
Abstract
AIMS Family history is a known risk factor for early-onset myocardial infarction (EOMI). However, the role of modifiable lifestyle and metabolic factors in EOMI risk is unclear and may differ from that of older adults. METHODS This case-control study included myocardial infarction (MI) patients aged ≤45 years from the Bremen ST-elevation MI Registry and matched controls randomly selected from the general population (German National Cohort) at the same geographical region. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the individual and combined associations of lifestyle and metabolic factors with EOMI risk, overall and according to family history for premature MI. RESULTS A total of 522 cases and 1191 controls were included. Hypertension, current smoking, elevated waist-to-hip ratio, and diabetes mellitus were strongly associated with the occurrence of EOMI. By contrast, higher frequency of alcohol consumption was associated with decreased EOMI risk. In a combined analysis of the risk factors hypertension, current smoking, body mass index ≥25.0 kg/sqm, and diabetes mellitus, participants having one (OR = 5.4, 95%CI = 2.9-10.1) and two or more risk factors (OR = 42.3, 95%CI = 22.3-80.4) had substantially higher odds of EOMI compared to those with none of these risk factors, regardless of their family history. CONCLUSION This study demonstrates a strong association of smoking and metabolic risk factors with the occurrence of EOMI. The data suggest that the risk of EOMI goes beyond family history and underlines the importance of primary prevention efforts to reduce smoking and metabolic syndrome in young persons.
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Affiliation(s)
- Harm Wienbergen
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany.,Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany
| | - Daniel Boakye
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Kathrin Günther
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Johannes Schmucker
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Luis Alberto Mata Marín
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Hatim Kerniss
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Rajini Nagrani
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Luise Struß
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Stephan Rühle
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Tina Retzlaff
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Andreas Fach
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Rico Osteresch
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Rainer Hambrecht
- Bremen Institute for Heart and Circulation Research (BIHKF) at the Klinikum Links der Weser, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
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Kolden MØ, Nymo SH, Øie E. Impact of neighbourhood-level socioeconomic status, traditional coronary risk factors, and ancestry on age at myocardial infarction onset: A population-based register study. BMC Cardiovasc Disord 2022; 22:447. [PMID: 36289452 PMCID: PMC9608887 DOI: 10.1186/s12872-022-02880-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is consensus that low socioeconomic status (SES) is associated with an increased risk of acute myocardial infarction (AMI), but the extent to which traditional coronary risk factors and other characteristics of low SES mediate this effect remains uncertain. This study examined AMI patients residing in neighbouring city districts with the same local hospital despite having among the most considerable differences in mean SES in Norway. Our purpose was to assess low SES as a coronary risk factor and examine whether traditional coronary risk factors or ancestry mediate this effect. Methods Six hundred six patients (215 and 391 with a low and high neighbourhood-level SES, respectively) admitted to Diakonhjemmet Hospital with non-ST-elevation myocardial infarction (NSTEMI) between 2014 and 2017, entered analysis. Data from the Norwegian Myocardial Infarction Register were used to identify patient characteristics, and the STATA/SE 15.1 software was used to perform the statistical analyses. Results Patients from socioeconomically disadvantaged city-districts had a 4.9 years earlier onset of AMI (68.99 vs. 73.89 years; p < 0.001) and a higher prevalence of previous AMI, known diabetes, and current smokers (36% vs. 27%, 25% vs. 12%, and 33% vs. 17%, respectively; all p ≤ 0.05). When only comparing patients with a first time AMI, an even greater difference in the age at AMI onset was found (6.1 yrs; p < 0.001). The difference in age at AMI onset remained statistically significant when adjusting for traditional coronary risk factors (3.28 yrs; 95% confidence interval (CI) 1.11−5.44; p = 0.003), but not when adjusting for presumed non-Northwest-European ancestry (1.81 yrs; 95% CI −0.55 to 4.17; p = 0.132). Conclusion This study supports earlier research showing an increased risk of AMI in socioeconomically disadvantaged individuals. In our population, presumed non-Northwest-European ancestry could entirely explain the increased risk, whereas traditional coronary risk factors could only partly explain the increased risk.
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Affiliation(s)
- Mathias Øie Kolden
- grid.413684.c0000 0004 0512 8628Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Ståle H. Nymo
- grid.413684.c0000 0004 0512 8628Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik Øie
- grid.413684.c0000 0004 0512 8628Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
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Long J, Zeng F, Wang L, Zhao H. Association between Education Attainment and Guideline-Directed Medication Therapy in Patients with Heart Failure and Reduced Ejection Fraction. J Clin Med 2022; 11:jcm11144235. [PMID: 35887999 PMCID: PMC9319771 DOI: 10.3390/jcm11144235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: The aim of the current study was to evaluate association of education attainment and guideline-directed medications therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). Method: HFrEF patients were enrolled, and baseline characteristics were recorded. Based on highest educational attainment, patients were divided into low and high education attainment groups. Data on GDMT use at admission, discharge and follow-up were collected and between-group differences were evaluated. Results: A total of 336 patients were recruited, and 59.8% (n = 201) were defined as low education attainment. Patients with low education attainment were older and more likely to be female, obese and smokers. In addition, they had a higher prevalence of hypertension and valvular heart disease. Patients with low education attainment also had lower physical and mental component scores (PCS, 50.5 ± 6.4 vs. 56.3 ± 7.8), (MSC, 48.4 ± 6.0 vs. 54.7 ± 5.6) but higher serum NT-proBNP levels (1148.6 ± 233.4 vs. 1050.8 ± 205.6 pg/mL). Significant differences in GDMT use at admission, discharge and follow-up were observed. In the unadjusted model, high education attainment was associated with 2-fold odds of GDMT use at discharge. With adjustment for covariates, the high education attainment group remained significantly associated with being 22% more likely to receive GMDT at discharge. Similar findings were observed in associations between high education attainment and GDMT use at follow-up. After adjustment for PCS and MCS, high education attainment was still significantly associated with GDMT use at follow-up, with odds ratio of 1.13 and a 95% confidence interval of 1.08–1.28. Conclusion: HFrEF patients are under-treated. Education attainment is significantly associated with GDMT use at discharge and follow-up.
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Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review. Int J Cardiol 2022; 356:19-29. [DOI: 10.1016/j.ijcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
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Sasko B, Jaehn P, Müller R, Andresen H, Müters S, Holmberg C, Ritter O, Pagonas N. Understanding the importance of social determinants and rurality for the long-term outcome after acute myocardial infarction: study protocol for a single-centre cohort study. BMJ Open 2022; 12:e056888. [PMID: 35428636 PMCID: PMC9013987 DOI: 10.1136/bmjopen-2021-056888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a major public health issue in Germany with considerable regional differences in morbidity and mortality. Possible reasons for regional differences include a higher prevalence of cardiovascular risk factors, infrastructural deficits, different levels of healthcare quality or social determinants. We aim to study associations of social determinants and of rural infrastructure with the quality of medical care (eg, time to reperfusion or medication adherence) and on the long-term outcome after myocardial infarction. METHODS AND ANALYSIS We will employ a prospective cohort study design. Patients who are admitted with AMI will be invited to participate. We aim to recruit a total of 1000 participants over the course of 5 years. Information on outpatient care prior to AMI, acute healthcare of AMI, healthcare-related environmental factors and social determinants will be collected. Baseline data will be assessed in interviews and from the electronic data system of the hospital. Follow-up will be conducted after an observation period of 1 year via patient interviews. The outcomes of interest are cardiac and all-cause mortality, changes in quality of life, changes in health status of heart failure, major adverse cardiovascular events and participation in rehabilitation programmes. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of Brandenburg Medical School (reference: E-01-20200923). Research findings will be disseminated and shared in different ways and include presenting at international and national conferences, publishing in peer-reviewed journals and facilitating dissemination workshops within local communities with patients and healthcare professionals. TRIALS REGISTRATION NUMBER DRKS00024463.
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Affiliation(s)
- Benjamin Sasko
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Rhea Müller
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Henrike Andresen
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stephan Müters
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Oliver Ritter
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Nikolaos Pagonas
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Schmucker J, Fach A, Osteresch R, Mata Marin LA, Retzlaff T, Rühle S, Garstka D, Kuhlmann U, Eitel I, Hambrecht R, Wienbergen H. Temporal trends in treatment strategies and clinical outcomes among patients with advanced chronic kidney disease and ST-elevation myocardial infarctions: results from the Bremen STEMI registry. BMC Cardiovasc Disord 2022; 22:142. [PMID: 35365074 PMCID: PMC8976374 DOI: 10.1186/s12872-022-02573-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although the detrimental effects of advanced chronic kidney disease (CKD) on prognosis in coronary artery disease is known, there are few data on the efficacy and safety of modern interventional therapies and medications in patients with advanced CKD, because this special patient cohort is often excluded or underrepresented in randomized trials. Methods In the present study all patients admitted with ST-elevation myocardial infarctions (STEMI) from the region of Bremen/Germany treated between 2006 and 2019 were analyzed. Advanced CKD was defined as glomerular filtration rate < 45 ml/min.
Results Of 9605 STEMI-patients, 1018 (10.6%) had advanced CKD with a serum creatinine of 2.22 ± 4.2 mg/dl at admission and with lower rates of primary percutaneous coronary intervention (pPCI) (84.1 vs. 94.1%, p < 0.01) and higher all-cause-mortality (44.4 vs. 3.6%, p < 0.01). Over time, advanced CKD-patients were more likely to be treated with pPCI (2015–2019: 90.3% vs. 2006–2010:75.8%, p < 0.01) and with ticagrelor/prasugrel (59.6% vs. 1.7%, p < 0.01) and drug eluting stents (90.7% vs. 1.3%, p < 0.01). During the study period a decline in adverse ischemic events (OR 0.3, 95% CI 0.1–0.7) and an increase in bleedings (OR 2.2, 95% CI 1.3–3.8) within 1 year after the index event could be observed in patients with advanced CKD while 1-year-mortality (OR 1.0, 95% CI 0.7–1.4) and rates of acute kidney injury (OR 1.2, 95% CI 0.8–1.7) did not change in a multivariate model. Both, ticagrelor/prasugrel (OR 0.48, 95% CI 0.2–0.98) and DES (OR 0.38, 95% CI 0.2–0.8) were associated with a decrease in ischemic events at 1 year. Conclusions During the observed time period STEMI-patients with advanced CKD were more likely to be treated with primary PCI, ticagrelor or prasugrel and DE-stents. These changes probably have contributed to the decline in ischemic events and the increase in bleedings within 1 year after STEMI while overall mortality at 1-year remained unchanged for this high-risk patient group.
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Affiliation(s)
- Johannes Schmucker
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany. .,Medical Clinic III, Department of Nephrology and Cardiology, Klinikum Bremen Mitte, Bremen, Germany.
| | - Andreas Fach
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Rico Osteresch
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Luis Alberto Mata Marin
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Tina Retzlaff
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Stephan Rühle
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Daniela Garstka
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Uwe Kuhlmann
- Medical Clinic III, Department of Nephrology and Cardiology, Klinikum Bremen Mitte, Bremen, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center, Lübeck, Germany
| | - Rainer Hambrecht
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Harm Wienbergen
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany.,Medical Clinic II, University Heart Center, Lübeck, Germany
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10
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Daley S, Kajendrakumar B, Nandhakumar S, Personett C, Sholes M, Thapa S, Xue C, Korvink M, Gunn LH. County-Level Socioeconomic Status Adjustment of Acute Myocardial Infarction Mortality Hospital Performance Measure in the U.S. Healthcare (Basel) 2021; 9:healthcare9111424. [PMID: 34828471 PMCID: PMC8620965 DOI: 10.3390/healthcare9111424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
The U.S. Centers for Medicare and Medicaid Services’ (CMS’s) Hospital Compare (HC) data provides a collection of risk-adjusted hospital performance metrics intended to allow comparison of hospital-provided care. However, CMS does not adjust for socioeconomic status (SES) factors, which have been found to be associated with disparate health outcomes. Associations between county-level SES factors and CMS’s risk-adjusted 30-day acute myocardial infarction (AMI) mortality rates are explored for n = 2462 hospitals using a variety of sources for county-level SES information. Upon performing multiple imputation, a stepwise backward elimination model selection approach using Akaike’s information criteria was used to identify the optimal model. The resulting model, comprised of 14 predictors mostly at the county level, provides an additional 8% explanatory power to capture the variability in 30-day risk-standardized AMI mortality rates, which already account for patient-level clinical differences. SES factors may be an important feature for inclusion in future risk-adjustment models, which will have system and policy implications for distributing resources to hospitals, such as reimbursements. It also serves as a stepping stone to identify and address long-standing SES-related inequities.
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Affiliation(s)
- Sean Daley
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Bakthameera Kajendrakumar
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
| | - Samyuktha Nandhakumar
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Christine Personett
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Michael Sholes
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Swornim Thapa
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Chen Xue
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | | | - Laura H. Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (S.D.); (B.K.); (S.N.); (C.P.); (M.S.); (S.T.); (C.X.)
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
- Faculty of Medicine, School of Public Health, Imperial College London, London W6 8RP, UK
- Correspondence:
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11
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Rose N, Matthäus-Krämer C, Schwarzkopf D, Scherag A, Born S, Reinhart K, Fleischmann-Struzek C. Association between sepsis incidence and regional socioeconomic deprivation and health care capacity in Germany - an ecological study. BMC Public Health 2021; 21:1636. [PMID: 34493250 PMCID: PMC8424852 DOI: 10.1186/s12889-021-11629-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking. Methods Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions. Results In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts. Conclusions Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11629-4.
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Affiliation(s)
- Norman Rose
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Claudia Matthäus-Krämer
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Daniel Schwarzkopf
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Sebastian Born
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carolin Fleischmann-Struzek
- Center for Sepsis Control and Care, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany. .,Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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12
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Schmucker J, Fach A, Osteresch R, Mata Marin LA, Ruehle S, Retzlaff T, Garstka D, Eitel I, Hambrecht R, Wienbergen H. Efficacy of Drug-Eluting Stents in Diabetic Patients Admitted with ST-Elevation Myocardial Infarctions Treated with Primary Percutaneous Coronary Intervention. J Cardiovasc Dev Dis 2021; 8:jcdd8080083. [PMID: 34436225 PMCID: PMC8397182 DOI: 10.3390/jcdd8080083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Diabetic patients show higher adverse ischemic event rates and mortality when undergoing percutaneous coronary intervention (PCI) in acute myocardial infarctions. Therefore, diabetic patients might benefit even more from modern-generation drug-eluting stents (DES). The aim of the present study was to compare adverse ischemic events and mortality rates between bare-metal stents (BMS) and DES in diabetic patients admitted with ST-elevation-myocardial infarction (STEMI) with non-diabetic patients as the control group. Methods: All STEMI patients undergoing emergency PCI and stent implantation documented between 2006 and 2019 in the Bremen STEMI registry entered the analysis. Efficacy was defined as a combination of in-stent thrombosis, myocardial re-infarction or additional target lesion revascularization at one year. Results: Of 8356 patients which entered analysis, 1554 (19%) were diabetics, while 6802 (81%) were not. 879 (57%) of the diabetics received a DES. In a multivariate model, DES implantation in diabetics compared to BMS was associated with lower rates of in-stent thrombosis (OR 0.16, 95% CI 0.05–0.6), myocardial re-infarctions (OR 0.35, 95%CI, 0.2–0.7, p < 0.01) and of the combined endpoint at 1 year ((ST + MI + TLR): OR 0.31, 95% CI 0.2–0.6, p < 0.01), with a trend towards lower 5-year mortality (OR 0.56, 95% CI 0.3–1.0, p = 0.058). When comparing diabetic to non-diabetic patients, an elevation in event rates for diabetics was only detectable in BMS (OR 1.78, 95% CI 0.5–0.7, p < 0.01); however, this did not persist when treated with a DES (OR 1.03 95% CI 0.7–1.6, p = 0.9). Conclusions: In STEMI patients with diabetes, the use of DES significantly reduced ischemic event rates and, unlike with BMS, adverse ischemic event rates became similar to non-diabetic patients.
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Affiliation(s)
- Johannes Schmucker
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
- Correspondence: ; Tel.: +49-421-879-1430; Fax: +49-421-879-1675
| | - Andreas Fach
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
| | - Rico Osteresch
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
| | - Luis Alberto Mata Marin
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
| | - Stephan Ruehle
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
| | - Tina Retzlaff
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
| | - Daniela Garstka
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
| | - Ingo Eitel
- Medical Clinic II, University Heart Center, 23562 Lübeck, Germany;
| | - Rainer Hambrecht
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
| | - Harm Wienbergen
- Bremen Institute for Heart and Circulation Research, 28277 Bremen, Germany; (A.F.); (R.O.); (L.A.M.M.); (S.R.); (T.R.); (D.G.); (R.H.); (H.W.)
- Medical Clinic II, University Heart Center, 23562 Lübeck, Germany;
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13
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Mata Marín LA, Schmucker J, Fach A, Osteresch R, Rühle S, Garstka D, Eitel I, Hambrecht R, Wienbergen H. Prevalence and clinical characteristics of prediabetes and diabetes mellitus in young patients with ST-segment elevation myocardial infarction. Clin Res Cardiol 2021; 110:1647-1658. [PMID: 34216252 DOI: 10.1007/s00392-021-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Only few data on the prevalence of DM in young patients with ST-elevation myocardial infarction (STEMI) exist. Aim of the present study was to analyse this prevalence, its association to other cardiovascular risk factors and its impact on severity of CAD. In a substudy, consecutive HbA1c measurements in each patient were evaluated. METHODS All patients ≤ 45 years old, admitted with STEMI to an overregional German Heart Centre and treated with primary coronary intervention between 2006 and 2019, entered analysis. Since 2015 HbA1c measurements were performed to detect unknown dysglycaemia. RESULTS Out of 776 young patients of the total cohort, 88 patients (11.4%) had a DM, while 688 (88.6%) did not. Diabetics were more likely to be obese (BMI ≥ 30 kg/m2, OR 2.4, 95%CI 1.4-4.0, p < 0.01) and very obese (BMI ≥ 40 kg/m2, OR 5.1, 95%CI 2.1-12.2, p < 0.01). In diabetics, a higher likelihood of subacute STEMI (OR 2.2, 95% CI 1.1-4.5, p < 0.05) and more advanced CAD (OR 1.6, 95% CI 1.0-2.6, p < 0.05) compared to non-diabetics was observed. 208 patients were included in the substudy with HbA1c measurements. Out of those, 26 patients (12%) had known DM, while 17 patients (8%) had newly diagnosed DM and 49 patients (24%) preDM. The combined prevalence of any type of dysglycaemia was 44%. CONCLUSION DM in young patients with STEMI was associated with (severe) obesity, a higher likelihood of subacute STEMI and more advanced CAD compared to non-diabetics. Measurement of HbA1c in every consecutive STEMI-patient increased the rate of detected dysglycaemias more than three times higher than in general population.
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Affiliation(s)
- Luis Alberto Mata Marín
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany.
| | - Johannes Schmucker
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Andreas Fach
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Rico Osteresch
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Stephan Rühle
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Daniela Garstka
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Centre Lübeck, Lübeck, Germany
| | - Rainer Hambrecht
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Harm Wienbergen
- Bremen Institute for Heart and Circulation Resarch, Klinikum Links Der Weser, Stiftung Bremer Herzen, Senator-Weßling-Str. 1, 28277, Bremen, Germany.,Medical Clinic II, University Heart Centre Lübeck, Lübeck, Germany
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14
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Lueckmann SL, Mlinarić M, Richter M. [Social inequalities in healthcare provision for patients with coronary heart disease: Results from the GEDA (German Health Update) study 2014/2015]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 160:48-54. [PMID: 33451924 DOI: 10.1016/j.zefq.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Little is known about social inequalities in outpatient long-term care of coronary heart disease (CHD) in Germany. METHODS Regression analyses are based on the responses of women and men who participated in the national cross-sectional study "German Health update" (GEDA) 2014/2015 and had self-reported CHD (N=920). Outpatient healthcare of CHD was analysed on the basis of the self-reported administration of antihypertensive and cholesterol-lowering drugs, and the frequency of general practitioner (GP) contacts. RESULTS On average, respondents visited their GP 7.5 times a year (mean). 46 % did not receive guideline-consistent treatment, i. e. both antihypertensive and cholesterol-lowering drugs. Respondents of lower social status consulted their GP more frequently (approx. two visits per year) than those of higher social status (AME: 1.94; 95% CI 0.56 to 3.31). Regarding treatment with antihypertensive and cholesterol-lowering drugs, there were no significant differences for either gender or social status. Nevertheless, the probability that respondents with increased levels of blood lipids or cholesterol took only one or none of the two medications recommended for long-term treatment of CHD was reduced by 54 percentage points (AME: -0,54; 95% CI -0,61 to -0,48). DISCUSSION There are no social inequalities in the treatment of CHD patients with antihypertensive and cholesterol-lowering drugs, but inequalities exist in the frequency of visits to the GP who is more often consulted by the more socially disadvantaged patients. CONCLUSION With about 7.5 consultations per year, CHD patients visit their general practitioner more often than average, but in about half of these patients the medication supply is less than optimal. This may indicate a deficit in the medical treatment of CHD that cannot be explained by social inequalities. A possible starting point for improving healthcare, especially for patients without other risk factors, is to focus more strongly on a guideline-based approach to prescribing medication for CHD patients.
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Affiliation(s)
- Sara L Lueckmann
- Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Martin Mlinarić
- Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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15
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Wienbergen H, Fach A, Langer H, Hambrecht R. Update Lebensstil – Was funktioniert in der Praxis? AKTUELLE KARDIOLOGIE 2020. [DOI: 10.1055/a-1130-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungAktuelle Versorgungsstudien zeigen eine alarmierende Zunahme Lebensstil-assoziierter kardiovaskulärer Risikofaktoren, wie Adipositas und körperliche Inaktivität, in der Gesamtbevölkerung und bei Patienten mit Herz-Kreislauf-Erkrankungen. Um dem entgegenzuwirken, ist es wichtig, Patienten nach Koronarereignissen langfristig zu Verhaltensänderungen zu motivieren. Eine kürzlich publizierte Studie zeigte, dass ein intensives Präventionsprogramm (IPP) für 12 Monate, das primär von nicht ärztlichen Präventionsassistenten durchgeführt wurde und auf engmaschigen Kontakten zu den Patienten beruhte, die kardiovaskulären Risikofaktoren nachhaltig besser einstellen konnte. In der Gesamtbevölkerung ist eine Anleitung zu Lebensstilmodifikationen in verschiedenen Lebensphasen wichtig: beginnend im Kindes- und Jugendalter, über das Berufsleben, bis hin zum Rentenalter. Ein besonders hoher Bedarf besteht in Bevölkerungsschichten mit niedrigem sozioökonomischen Status. Durch präventive
Maßnahmen, wie Aufklärung zu mehr Bewegung, gesunder Ernährung und Nicht-Rauchen, kann hier ein großer Beitrag geleistet werden, die kardiovaskuläre Morbidität und Letalität zu senken.
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Affiliation(s)
- Harm Wienbergen
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II, Lübeck
| | - Andreas Fach
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
| | - Harald Langer
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II, Lübeck
| | - Rainer Hambrecht
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
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16
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Schmucker J, Fach A, Mata Marin LA, Retzlaff T, Osteresch R, Kollhorst B, Hambrecht R, Pohlabeln H, Wienbergen H. Efficacy and Safety of Ticagrelor in Comparison to Clopidogrel in Elderly Patients With ST-Segment-Elevation Myocardial Infarctions. J Am Heart Assoc 2019; 8:e012530. [PMID: 31538856 PMCID: PMC6818018 DOI: 10.1161/jaha.119.012530] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Current guidelines recommend the new-generation P2Y12-inhibitor ticagrelor for patients with acute ST-segment-elevation myocardial infarctions (STEMIs). The aim of the present study was to assess efficacy and safety of ticagrelor for elderly patients with STEMI (≥75 years) in an all-comers STEMI registry. Methods and Results Patients with STEMI, aged ≥75 years, treated with primary percutaneous coronary intervention and documented in the Bremen STEMI Registry between 2006 and 2017 entered analysis. The primary efficacy outcome, major adverse cardiac and cerebrovascular events, was defined as a composite of death, myocardial reinfarction, and stroke. The safety outcome was defined as any significant bleeding event within 1 year. To estimate benefit/risk ratio, net adverse clinical events (major adverse cardiac and cerebrovascular events+bleedings) were calculated. Outcomes were estimated in propensity score-matched cohorts to adjust for possible confounders. Of a total of 7466 patients with STEMI, 1087, aged ≥75 years, were selected, of which 552 (51%) received clopidogrel and 535 (49%) received ticagrelor, with similar age (80.9±4.6 versus 80.9±4.6 years) and sex (51% versus 50% female) distributions between treatment arms. The primary efficacy outcome occurred in 32.4% of patients treated with clopidogrel versus 25.5% treated with ticagrelor (P=0.015), with the 1-year mortality rate at 26.8% versus 21.1% (P=0.035). Because there was no difference in the safety outcome (clopidogrel versus ticagrelor, 4.9% versus 5.1%; not significant), net adverse clinical events were higher for clopidogrel than for ticagrelor: 37.3% versus 30.6% (P=0.028). In a propensity score-matched model, the advantage for ticagrelor on major adverse cardiac and cerebrovascular events remained significant (hazard ratio, 0.69; 95% CI, 0.49-0.97; P=0.03), whereas 1-year-mortality (hazard ratio, 0.89; 95% CI, 0.67-1.27; P=0.5) and 1-year bleeding events (hazard ratio, 1.1; 95% CI, 0.4-2.3; P=0.8) did not differ. Conclusions These results from propensity score-matched registry data show that for elderly patients with STEMI, ticagrelor compared with clopidogrel was associated with a reduction in major adverse cardiac and cerebrovascular events without a significant increase in bleeding events within 1 year.
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Affiliation(s)
- Johannes Schmucker
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Andreas Fach
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | | | - Tina Retzlaff
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Rico Osteresch
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Bianca Kollhorst
- Leibniz-Institut für Präventionsforschung und Epidemiologie Bremen Germany
| | - Rainer Hambrecht
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Hermann Pohlabeln
- Leibniz-Institut für Präventionsforschung und Epidemiologie Bremen Germany
| | - Harm Wienbergen
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
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Long-Term Risk Factor Control After Myocardial Infarction-A Need for Better Prevention Programmes. J Clin Med 2019; 8:jcm8081114. [PMID: 31357619 PMCID: PMC6723668 DOI: 10.3390/jcm8081114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 01/30/2023] Open
Abstract
Introduction: Long-term prognosis of myocardial infarction (MI) is still serious, especially in patients with MI and cardiogenic shock. To improve long-term prognosis and prevent recurrent events, sustainable cardiovascular risk factor control (RFC) after MI is crucial. Methods: The article gives an overview on health care data regarding RFC after MI and presents recent trials on modern preventive strategies that support patients to achieve risk factor targets during long-term course. Results: International registry studies, such as EUROASPIRE, observed alarming deficiencies in RFC after MI. As data of the German Bremen ST-segment elevation myocardial infarction (STEMI)-Registry show, most deficiencies are found in socially disadvantaged city districts and in young patients. Several studies on prevention programmes to improve RFC after MI reported inconsistent data; however, in the recently published IPP trial a 12-months intensive prevention programme that included both repetitive personal contacts with non-physician prevention assistants and telemetric risk factor control, was associated with significant improvements of numerous risk factors (smoking, LDL and total cholesterol, systolic blood pressure and physical inactivity). Conclusions: There is a strong need of action to improve long-term risk RFC after MI, especially in socially disadvantaged patients. Modern prevention programmes, using personal and telemetric contacts, have large potential to support patients in achieving long-term risk factor targets after coronary events.
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