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Jarab AS, Mansour RZ, Muflih S, Al-Qerem W, Abu Heshmeh SR, Alzoubi KH, Al Hamarneh YN, Aburuz S, Al Momany EM. Determinants of Health-Related Quality of Life in Outpatients with Myocardial Infarction. J Multidiscip Healthc 2024; 17:2133-2145. [PMID: 38736536 PMCID: PMC11088373 DOI: 10.2147/jmdh.s463789] [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: 02/11/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Background The health-related quality of life (HRQOL) of patients with myocardial infarction (MI) is suboptimal because of the disease's life-threatening nature, the requirement for long-term lifestyle modifications, and the treatment regimens following MI. This study aimed to evaluate HRQOL and its associated factors in MI patients. Material and Methods This study was conducted on patients with MI who attended the outpatient cardiology clinic at a major teaching hospital in Jordan. The EQ-5D-3L questionnaire was used to assess HRQOL of the study participants. Quantile regression analysis was conducted to identify the variables associated with HRQOL. Results The study included 333 patients with a history of MI, with a median age of 58 (57-60). The median of the total EQ-5D score was 0.65 (0.216-0.805). Regression results revealed that male patients (Coefficient= 0.110, 95%Cl (0.022-0.197), P=0.014) and not being diagnosed with diabetes (Coefficient= 0.154, 95%Cl (0.042-0.266), P=0.007) were associated with increased HRQOL. On the other hand, low income (Coefficient= -0.115, 95%Cl (-0.203 - -0.026), P=0.011), not receiving DPP-4 (Dipeptidyl Peptidase -4) inhibitors (Coefficient= -0.321 95%Cl (-0.462 - -0.180), P<0.001), and having low (Coefficient= -0.271, 95%Cl (-0.395 - -0.147), P<0.001) or moderate (Coefficient= -0.123, 95%Cl (-0.202 - -0.044), P=0.002) medication adherence was associated with decreased HRQOL. Conclusion The current study demonstrated diminished HRQOL among patients with MI, highlighting the necessity of tailoring interventions to tackle medication adherence barriers in this population. Personalized interventions such as educational programs, counseling, and reminders that consider each patient's needs and circumstances can greatly enhance medication adherence and, thus, the HRQOL of MI patients. Individuals with lower income levels, female patients, and those with diabetes should be the specific targets of these interventions.
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Affiliation(s)
- Anan S Jarab
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Razan Z Mansour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Suhaib Muflih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, 11733, Jordan
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Yazid N Al Hamarneh
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Salah Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Enaam M Al Momany
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
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Li T, Hu W, Han Q, Wang Y, Ma Z, Chu J, He Q, Feng Z, Sun N, Shen Y. Trajectories of quality of life and cognition in different multimorbidity patterns: Evidence from SHARE. Arch Gerontol Geriatr 2024; 117:105219. [PMID: 37812973 DOI: 10.1016/j.archger.2023.105219] [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: 07/23/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The study aimed to observe the trajectory of quality of life (QoL) and cognition, and to a analyze the bidirectional association between cognition and QoL for diverse multimorbidity patterns. METHODS In total, 16,153 older participants age ≥50 years were included from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used latent class analysis (LCA) to identify multimorbidity patterns in the baseline population. We used linear mixed models (LMM) to examine the trajectory of cognition and QoL in different multimorbidity patterns. A cross-lagged model was employed to analyze the bidirectional association between cognition and QoL in diverse multimorbidity patterns. RESULTS Latent class analysis identified four multimorbidity patterns: high and low comorbidity burden (HC and LC), cardiometabolic (CA), and osteoarthrosis (OS). The HC group had the poorest cognitive function and QoL (p for trend < 0.001). Delayed and immediate episodic memory in the OS group declined at a highest rate (p for trend < 0.001). Additionally, a bidirectional association between cognition and QoL was observed. The effect of cognitive function on QoL was relatively stronger than the reverse in the CA and LC groups. CONCLUSIONS The rate of decline in cognition and QoL over the time differs in diverse multimorbidity patterns, and patients with four or more chronic diseases should be specially considered. Notably, early monitoring of cognitive function and can help break the vicious cycle between cognitive deterioration and poor QoL in patients with OS or CA diseases.
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Affiliation(s)
- Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Wei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Ze Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Jiadong Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Qida He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, China.
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Hayward CJ, Batty JA, Westhead DR, Johnson O, Gale CP, Wu J, Hall M. Disease trajectories following myocardial infarction: insights from process mining of 145 million hospitalisation episodes. EBioMedicine 2023; 96:104792. [PMID: 37741008 PMCID: PMC10520333 DOI: 10.1016/j.ebiom.2023.104792] [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: 05/18/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Knowledge of post-myocardial infarction (MI) disease risk to date is limited-yet the number of survivors of MI has increased dramatically in recent decades. We investigated temporally ordered sequences of all conditions following MI in nationwide electronic health record data through the application of process mining. METHODS We conducted a national retrospective cohort study of all hospitalisations (145,670,448 episodes; 34,083,204 individuals) admitted to NHS hospitals in England (1st January 2008-31st January 2017, final follow-up 27th March 2017). Through process mining, we identified trajectories of all major disease diagnoses following MI and compared their relative risk (RR) and all-cause mortality hazard ratios (HR) to a risk-set matched non-MI control cohort using Cox proportional hazards and flexible parametric survival models. FINDINGS Among a total of 375,669 MI patients (130,758 females; 34.8%) and 1,878,345 matched non-MI patients (653,790 females; 34.8%), we identified 28,799 unique disease trajectories. The accrual of multiple circulatory diagnoses was more common amongst MI patients (RR 4.32, 95% CI 3.96-4.72) and conferred an increased risk of death (HR 1.32, 1.13-1.53) compared with matched controls. Trajectories featuring neuro-psychiatric diagnoses (including anxiety and depression) following circulatory disorders were markedly more common and had increased mortality post MI (HR ranging from 1.11 to 1.73) compared with non-MI individuals. INTERPRETATION These results provide an opportunity for early intervention targets for survivors of MI-such as increased focus on the psychological and behavioural pathways-to mitigate ongoing adverse disease trajectories, multimorbidity, and premature mortality. FUNDING British Heart Foundation; Alan Turing Institute.
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Affiliation(s)
- Christopher J Hayward
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan A Batty
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - David R Westhead
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; School of Molecular and Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Owen Johnson
- School of Computing, Faculty of Engineering and Physical Sciences, University of Leeds, LS2 9JT, UK
| | - Chris P Gale
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, E1 4NS, UK
| | - Marlous Hall
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK.
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Soloveva A, Gale CP, Han NT, Hurdus B, Aktaa S, Palin V, Mebrahtu TF, Van Spall H, Batra G, Dondo TB, Bäck M, Munyombwe T. Associations of health-related quality of life with major adverse cardiovascular and cerebrovascular events for individuals with ischaemic heart disease: systematic review, meta-analysis and evidence mapping. Open Heart 2023; 10:e002452. [PMID: 37890894 PMCID: PMC10619110 DOI: 10.1136/openhrt-2023-002452] [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: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD). METHODS Medline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the studies. Descriptive synthesis, evidence mapping and random-effects meta-analysis were performed stratified by HRQoL measures and effect estimates. Between-study heterogeneity was assessed using the Higgins I2 statistic. RESULTS Fifty-one articles were included with a total of 134 740 participants from 53 countries. Meta-analysis of 23 studies found that the risk of MACCE increased with lower baseline HeartQoL score (HR 1.49, 95% CI 1.16 to 1.93) and Short Form Survey (SF-12) physical component score (PCS) (HR 1.39, 95% CI 1.28 to 1.51). Risk of all-cause mortality increased with a lower HeartQoL (HR 1.64, 95% CI 1.34 to 2.01), EuroQol 5-dimension (HR 1.17, 95% CI 1.12 to 1.22), SF-36 PCS (HR 1.29, 95% CI 1.19 to 1.41), SF-36 mental component score (HR 1.18, 95% CI 1.08 to 1.30). CONCLUSIONS This study found an inverse association between baseline values or change in HRQoL and MACCE or components of MACCE in individuals with IHD, albeit with between-study heterogeneity. Standardisation and routine assessment of HRQoL in clinical practice may help risk stratify individuals with IHD for tailored interventions. PROSPERO REGISTRATION NUMBER CRD42021234638.
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Affiliation(s)
- Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research Centre, Sankt-Peterburg, Russian Federation
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Naung Tun Han
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Ben Hurdus
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Suleman Aktaa
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Victoria Palin
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Teumzghi F Mebrahtu
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Harriette Van Spall
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Gorav Batra
- Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tatendashe Bernadette Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Maria Bäck
- Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
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Yang K, Yang S, Chen Y, Cao G, Xu R, Jia X, Hou L, Li J, Bi C, Wang X. Multimorbidity Patterns and Associations with Gait, Balance and Lower Extremity Muscle Function in the Elderly: A Cross-Sectional Study in Northwest China. Int J Gen Med 2023; 16:3179-3192. [PMID: 37533839 PMCID: PMC10392815 DOI: 10.2147/ijgm.s418015] [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: 04/20/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose Fall is a common geriatric syndrome leading to various adverse outcomes in the elderly. Gait and balance disorders and decreased lower extremity muscle function are the major intrinsic risk factors of falls, and studies suggested that they were closely related to the underlying chronic conditions. This study aimed to explore the patterns of multimorbidity and determine the associations of these multimorbidity patterns with gait, balance and lower extremity muscle function. Patients and Methods A cross-sectional survey of 4803 participants aged ≥60 years in Shaanxi Province, China was conducted and the self-reported chronic conditions were investigated. The 6-m walk test, timed-up-and-go test (TUG) and 5-sit-to-stand test (5-STS) were conducted to evaluate gait, balance, and lower extremity muscle function respectively. Latent class analysis was used to explore patterns of multimorbidity, and multivariate regression analysis was used to determine the associations of multimorbidity patterns with gait, balance, and lower extremity muscle function. Results Five multimorbidity patterns were identified: Degenerative Disease Class, Cardio-metabolic Class, Stroke-Respiratory-Depression Class, Gastrointestinal Class, and Very sick Class, and they were differently associated with gait and balance disorders and decreased lower extremity muscle function. In particular, the multimorbidity patterns of Degenerative Disease Class and Stroke-Respiratory-Depression Class were closely associated with all the three risk factors of falls. Conclusion There are significant differences in the impact of different multimorbidity patterns on the major intrinsic risk factors of falls in the elderly population, and appropriate multimorbidity patterns are closely related to the prediction of falls and can help to develop fall prevention strategies in the elderly.
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Affiliation(s)
- Kaikai Yang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Shanru Yang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Yang Chen
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Guihua Cao
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Rong Xu
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Xin Jia
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Liming Hou
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Jinke Li
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Chenting Bi
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Xiaoming Wang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
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Savic L, Mrdovic I, Asanin M, Stankovic S, Lasica R, Matic D, Simic D, Krljanac G. Prognostic Impact of Non-Cardiac Comorbidities on Long-Term Prognosis in Patients with Reduced and Preserved Ejection Fraction following Acute Myocardial Infarction. J Pers Med 2023; 13:1110. [PMID: 37511723 PMCID: PMC10381839 DOI: 10.3390/jpm13071110] [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: 05/31/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND We aimed to analyze the prevalence and long-term prognostic impact of non-cardiac comorbidities in patients with reduced and preserved left-ventricular ejection fraction (EF) following ST-elevation myocardial infarction (STEMI). METHOD A total of 3033 STEMI patients undergoing primary percutaneous coronary intervention (pPCI) were divided in two groups: reduced EF < 50% and preserved EF ≥ 50%. The follow-up period was 8 years. RESULTS Preserved EF was present in 1726 (55.4%) patients and reduced EF was present in 1389 (44.5%) patients. Non-cardiac comorbidities were more frequent in patients with reduced EF compared with patients with preserved EF (38.9% vs. 27.4%, respectively, p < 0.001). Lethal outcome was registered in 240 (17.2%) patients with reduced EF and in 40 (2.3%) patients with preserved EF, p < 0.001. Diabetes and chronic kidney disease (CKD) were independent predictors for 8-year mortality in patients with preserved EF. In patients with reduced EF, CKD was independently associated with 8-year mortality. CONCLUSION In patients who had reduced EF, the prevalence of non-cardiac comorbidities was higher than in patients who had preserved EF after STEMI. Only diabetes mellitus and CKD were independently associated with 8-year mortality in analyzed patients.
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Affiliation(s)
- Lidija Savic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Igor Mrdovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Emergency Hospital, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Dragan Matic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Damjan Simic
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- University Clinical Center of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, 11000 Belgrade, Serbia
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Alarilla A, Mondor L, Knight H, Hughes J, Koné AP, Wodchis WP, Stafford M. Socioeconomic gradient in mortality of working age and older adults with multiple long-term conditions in England and Ontario, Canada. BMC Public Health 2023; 23:472. [PMID: 36906531 PMCID: PMC10008074 DOI: 10.1186/s12889-023-15370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND There is currently mixed evidence on the influence of long-term conditions and deprivation on mortality. We aimed to explore whether number of long-term conditions contribute to socioeconomic inequalities in mortality, whether the influence of number of conditions on mortality is consistent across socioeconomic groups and whether these associations vary by working age (18-64 years) and older adults (65 + years). We provide a cross-jurisdiction comparison between England and Ontario, by replicating the analysis using comparable representative datasets. METHODS Participants were randomly selected from Clinical Practice Research Datalink in England and health administrative data in Ontario. They were followed from 1 January 2015 to 31 December 2019 or death or deregistration. Number of conditions was counted at baseline. Deprivation was measured according to the participant's area of residence. Cox regression models were used to estimate hazards of mortality by number of conditions, deprivation and their interaction, with adjustment for age and sex and stratified between working age and older adults in England (N = 599,487) and Ontario (N = 594,546). FINDINGS There is a deprivation gradient in mortality between those living in the most deprived areas compared to the least deprived areas in England and Ontario. Number of conditions at baseline was associated with increasing mortality. The association was stronger in working age compared with older adults respectively in England (HR = 1.60, 95% CI 1.56,1.64 and HR = 1.26, 95% CI 1.25,1.27) and Ontario (HR = 1.69, 95% CI 1.66,1.72 and HR = 1.39, 95% CI 1.38,1.40). Number of conditions moderated the socioeconomic gradient in mortality: a shallower gradient was seen for persons with more long-term conditions. CONCLUSIONS Number of conditions contributes to higher mortality rate and socioeconomic inequalities in mortality in England and Ontario. Current health care systems are fragmented and do not compensate for socioeconomic disadvantages, contributing to poor outcomes particularly for those managing multiple long-term conditions. Further work should identify how health systems can better support patients and clinicians who are working to prevent the development and improve the management of multiple long-term conditions, especially for individuals living in socioeconomically deprived areas.
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Affiliation(s)
- Anne Alarilla
- The Health Foundation, 8 Salisbury Square, London, UK.
| | - Luke Mondor
- ICES, Toronto, ON, M4N 3M5, Canada
- Health System Performance Network, Toronto, ON, Canada
| | - Hannah Knight
- The Health Foundation, 8 Salisbury Square, London, UK
| | - Jay Hughes
- The Health Foundation, 8 Salisbury Square, London, UK
| | - Anna Pefoyo Koné
- Health System Performance Network, Toronto, ON, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Walter P Wodchis
- ICES, Toronto, ON, M4N 3M5, Canada
- Health System Performance Network, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Mai Stafford
- The Health Foundation, 8 Salisbury Square, London, UK
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Chen Y, Wu J, Tang Y, Li Z, Wen Q, Sun X, Yuan H, Lu Y, Cai J. Multimorbidity and combined interventions for patients with coronary heart disease in Chinese population: Latent class analysis of a multi-center study. Int J Cardiol 2022; 368:17-26. [PMID: 35963444 DOI: 10.1016/j.ijcard.2022.08.022] [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: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS This study aimed to explore the profile of multimorbidity phenotype clusters and their discrepancy in mortality and the efficiency of combined interventions on blood pressure, glucose and lipid in each cluster. METHODS Fine and Gray competing risk regression models and Kaplan-Meier curves were used to assess the association between multimorbidity and mortality and rehospitalization. Fine and Gray competing risk regression models and subgroup analyses were used to estimate the relations between combined interventions and mortality. RESULTS Three distinct multimorbidity clusters were observed: Class 1 named severe class, Class 2 termed moderate class, and Class 3 named mild class. Competing risk regression models revealed that patients in Class 1 have the greatest burden of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.43 (95% CI 1.30-1.56, P < 0.001) and 2.97 (95% CI 2.74-3.21, P < 0.001), respectively. The patients in Class 2 have moderate risk of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.41 (95% CI 1.30-1.52, P < 0.001) and 2.39 (95% CI 2.23-2.56, P < 0.001), respectively. Furthermore, we found that combined interventions on blood pressure, glucose and lipid simultaneously could further benefit on survival compared to each individual intervention or two in combine. CONCLUSIONS This study found that multimorbidity among patients with CHD was common and increased the risks of death and rehospitalization. Three multimorbidity clusters that were significantly associated with death and rehospitalization were identified. Simultaneous intervention on blood pressure, glucose and lipid level may further benefit CHD patient in survival.
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Affiliation(s)
- Yuanyuan Chen
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Junru Wu
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Yan Tang
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Zhengxin Li
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Qing Wen
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Xuejing Sun
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Hong Yuan
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China; The Center of Clinical Pharmacology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Yao Lu
- The Center of Clinical Pharmacology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China.
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China; The Center of Clinical Pharmacology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China.
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Beska B, Mills GB, Ratcovich H, Wilkinson C, Damluji AA, Kunadian V. Impact of multimorbidity on long-term outcomes in older adults with non-ST elevation acute coronary syndrome in the North East of England: a multi-centre cohort study of patients undergoing invasive care. BMJ Open 2022; 12:e061830. [PMID: 35882457 PMCID: PMC9330324 DOI: 10.1136/bmjopen-2022-061830] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Older adults have a higher degree of multimorbidity, which may adversely affect longer term outcomes from non-ST elevation acute coronary syndrome (NSTE-ACS). We investigated the impact of multimorbidity on cardiovascular outcomes 5 years after invasive management of NSTE-ACS. DESIGN Prospective cohort study. SETTING Multicentre study conducted in the north of England. PARTICIPANTS 298 patients aged ≥75 years with NSTE-ACS and referred for coronary angiography, with 264 (88.0%) completing 5-year follow-up. MAIN OUTCOME MEASURES Multimorbidity was evaluated at baseline with the Charlson comorbidity index (CCI). The primary composite outcome was all-cause mortality, myocardial infarction, stroke, urgent repeat revascularisation or significant bleeding. RESULTS Mean age was 80.9 (±6.1) years. The cohort median CCI score was 5 (IQR 4-7). The primary composite outcome occurred in 48.1% at 5 years, at which time 31.0% of the cohort had died. Compared with those with few comorbidities (CCI score 3-5), a higher CCI score (≥6) was positively associated with the primary composite outcome (adjusted HR (aHR) 1.64 (95% CI 1.14 to 2.35), p=0.008 adjusted for age and sex), driven by an increased risk of death (aHR 2.20 (1.38 to 3.49), p=0.001). For each additional CCI comorbidity, on average, there was a 20% increased risk of the primary composite endpoint at 5 years (aHR 1.20 (1.09 to 1.33), p<0.001). CONCLUSIONS In older adults with NSTE-ACS referred for coronary angiography, the presence of multimorbidity is associated with an increased risk of long-term adverse cardiovascular events, driven by a higher risk of all-cause mortality. TRIAL REGISTRATION NUMBER NCT01933581; ClinicalTrials.gov.
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Affiliation(s)
- Benjamin Beska
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Greg B Mills
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hanna Ratcovich
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Chris Wilkinson
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Wei Y, Wang F, Pan Z, Jin G, Wang D, Lu X, Cao Q. Work Content of General Practitioners in Beijing, China: A Multi-method Study. Front Public Health 2022; 10:870224. [PMID: 35570960 PMCID: PMC9096235 DOI: 10.3389/fpubh.2022.870224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the dramatic growth of primary care in China, little evidence showed what general practitioner (GP) do and how GP provided medical service in Beijing. Objective This study aimed to explore the work content of GPs in primary care in Beijing. Methods A multi-method study was conducted in five community health service institutions using non-participant observation and critical incident technique interview. Eleven GPs was recruited by purpose sampling, with each GP recording details of 100 patient encounters. Health problems of patients and activities of GPs were observed in consultations. Then, critical incident technique interviews were conducted focusing on GPs' works out of clinics and challenge. Results A total of 1, 100 patients encounters and 1,897 reasons for encounter (RFEs) were recorded from 11 GPs. There were 1897 RFEs (1.72 per encounter) and 2,762 health problems (2.51 per encounter) from 1,100 encounters during our observation. GPs' work related to consultation was focus on disease diagnoses and treatment. Physical examination and investigations were performed in only 15.5 and 17.1% consultations, respectively. Procedures for chronic disease management were infrequently provided to patients (0.4–26.6%). Time spent in each work process in consultations ranged from 0.68 ± 0.27 min for reservation to 4.00 ± 2.45 min for surgical treatment. In addition to clinical work, there were tasks about health files, contracted family doctor services, health education, teaching students, and scientific research. Conclusion This study illustrated the complexity of GPs' work and heavy workload in Beijing, China. More attention and effort are needed to develop GPs performance and release GPs' work workload in primary care.
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Affiliation(s)
- Yun Wei
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feiyue Wang
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Zhaolu Pan
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Guanghui Jin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Dawei Wang
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Qiumei Cao
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qiumei Cao
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