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Ganes A, Henderson J, Samuel R, Segan L, Hiew C, Hutchison A. Early coronary angiography in NSTEMI: a regional Victorian perspective. Intern Med J 2024. [PMID: 38958050 DOI: 10.1111/imj.16465] [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: 03/07/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Current guidelines highlight a paucity of evidence guiding optimal timing for non-ST-elevation myocardial infarction (NSTEMI) in high-risk and non-high-risk cases. AIM We assessed long-term major adverse cardiovascular events (MACEs) in NSTEMI patients undergoing early (<24 h) versus delayed (>24 h) coronary angiography at 6 years. Secondary end-points included all-cause mortality and cumulative MACE outcomes. METHODS Baseline characteristics and clinical outcomes were assessed among 355 patients presenting to a tertiary regional hospital between 2017 and 2018. Cox proportional hazard models were generated for MACE and all-cause mortality outcomes, adjusting for the Global Registry of Acute Coronary Events (GRACE) score, patient demographics, biomarkers and comorbidities. RESULTS Two hundred and seventy patients were included; 147 (54.4%) and 123 (45.6%) underwent early and delayed coronary angiography respectively. Median time to coronary angiography was 13.3 and 45.4 h respectively. At 6 years, 103 patients (38.1%) experienced MACE; 41 in the early group and 62 in the delayed group (hazard ratio (HR) = 2.23; 95% confidence interval (CI) = 1.50-3.31). After multivariable adjustment, the delayed group had higher rates of MACE (HR = 1.79; 95% CI = 1.19-2.70), all-cause mortality (HR = 2.76; 95% CI = 1.36-5.63) and cumulative MACE (incidence rate ratio = 1.54; 95% CI = 1.12-2.11). Subgroup analysis of MACE outcomes in rural and weekend NSTEMI presentations was not significant between early and delayed coronary angiography (HR = 1.49; 95% CI = 0.83-2.62). CONCLUSION Higher MACE rates in the delayed intervention group suggest further investigation is needed. Randomised control trials would be well suited to assess the role of early invasive intervention across all NSTEMI risk groups.
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Affiliation(s)
- Anand Ganes
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - James Henderson
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | | | | | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Adam Hutchison
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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Yamada R, Horikoshi T, Nakamura T, Uematsu M, Yamaguchi K, Kobayahi T, Ando R, Yoshizaki T, Watanabe Y, Kuroki K, Nakamura K, Sato A. Pretransfer Aspirin Administration and Its Impact on Angiographic Outcomes for Patients with ST-Elevation Myocardial Infarction. Int Heart J 2024; 65:21-28. [PMID: 38296575 DOI: 10.1536/ihj.23-389] [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] [Indexed: 02/08/2024]
Abstract
Although guidelines recommend early aspirin administration after diagnosis of ST-elevation myocardial infarction (STEMI), the decision of pretransfer aspirin administration is at the discretion of the primary physicians. Therefore, this study aimed to determine whether pretransfer aspirin administration was associated with better angiographical outcomes in patients with STEMI. This study compared the angiographic findings of thrombolysis in myocardial infarction (TIMI) flow grade in the infarct-related artery before percutaneous coronary intervention (PCI) between patients who received pretransfer aspirin and those who did not. In total, 28 patients (11.2%) were administered aspirin before transfer and 219 (88.8%) were administered aspirin upon arrival at the hospital. Propensity score matching yielded 135 patients [27 patients (20%) who were administered aspirin before transfer and 108 patients (80%) who were administered aspirin upon arrival at the hospital]. Patients who received pretransfer aspirin had a higher rate of TIMI-3 flow before PCI compared to those who did not receive pretransfer aspirin [8 (28.6%) versus 15 (6.8%), P < 0.01, in all study patients; 8 (26.6%) versus 7 (6.5%), P < 0.01, in propensity-score-matched patients]. Multivariable logistic regression analysis revealed that pretransfer aspirin administration was significantly associated with the presence of TIMI-3 flow before PCI, independent of age, gender, transfer time, and statin use (OR: 5.43, 95% CI: 1.94-15.2, P < 0.01, in all study patients; OR: 6.17, 95% CI: 1.86-20.46, P < 0.01, in propensity-score-matched patients). Pretransfer aspirin administration could lead to the early restoration of coronary blood flow in patients with STEMI, supporting its active use in STEMI care.
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Affiliation(s)
- Ryota Yamada
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Takeo Horikoshi
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Takamitsu Nakamura
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Manabu Uematsu
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Kazuyuki Yamaguchi
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Tsuyoshi Kobayahi
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Ryota Ando
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Toru Yoshizaki
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Yosuke Watanabe
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Kenji Kuroki
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Kazuto Nakamura
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
| | - Akira Sato
- Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine
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Ninno F, Tsui J, Balabani S, Díaz-Zuccarini V. A systematic review of clinical and biomechanical engineering perspectives on the prediction of restenosis in coronary and peripheral arteries. JVS Vasc Sci 2023; 4:100128. [PMID: 38023962 PMCID: PMC10663814 DOI: 10.1016/j.jvssci.2023.100128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Restenosis is a significant complication of revascularization treatments in coronary and peripheral arteries, sometimes necessitating repeated intervention. Establishing when restenosis will happen is extremely difficult due to the interplay of multiple variables and factors. Standard clinical and Doppler ultrasound scans surveillance follow-ups are the only tools clinicians can rely on to monitor intervention outcomes. However, implementing efficient surveillance programs is hindered by health care system limitations, patients' comorbidities, and compliance. Predictive models classifying patients according to their risk of developing restenosis over a specific period will allow the development of tailored surveillance, prevention programs, and efficient clinical workflows. This review aims to: (1) summarize the state-of-the-art in predictive models for restenosis in coronary and peripheral arteries; (2) compare their performance in terms of predictive power; and (3) provide an outlook for potentially improved predictive models. Methods We carried out a comprehensive literature review by accessing the PubMed/MEDLINE database according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy consisted of a combination of keywords and included studies focusing on predictive models of restenosis published between January 1993 and April 2023. One author independently screened titles and abstracts and checked for eligibility. The rest of the authors independently confirmed and discussed in case of any disagreement. The search of published literature identified 22 studies providing two perspectives-clinical and biomechanical engineering-on restenosis and comprising distinct methodologies, predictors, and study designs. We compared predictive models' performance on discrimination and calibration aspects. We reported the performance of models simulating reocclusion progression, evaluated by comparison with clinical images. Results Clinical perspective studies consider only routinely collected patient information as restenosis predictors. Our review reveals that clinical models adopting traditional statistics (n = 14) exhibit only modest predictive power. The latter improves when machine learning algorithms (n = 4) are employed. The logistic regression models of the biomechanical engineering perspective (n = 2) show enhanced predictive power when hemodynamic descriptors linked to restenosis are fused with a limited set of clinical risk factors. Biomechanical engineering studies simulating restenosis progression (n = 2) are able to capture its evolution but are computationally expensive and lack risk scoring for individual patients at specific follow-ups. Conclusions Restenosis predictive models, based solely on routine clinical risk factors and using classical statistics, inadequately predict the occurrence of restenosis. Risk stratification models with increased predictive power can be potentially built by adopting machine learning techniques and incorporating critical information regarding vessel hemodynamics arising from biomechanical engineering analyses.
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Affiliation(s)
- Federica Ninno
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, London, United Kingdom
| | - Stavroula Balabani
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Vanessa Díaz-Zuccarini
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
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Sangen H, Yamamoto T, Tara S, Kimura T, Narita N, Onodera K, Suzuki K, Matsuda J, Kadooka K, Takahashi K, Ko T, Hayashi H, Nakata J, Hosokawa Y, Akutsu K, Takano H, Masuno T, Yokobori S, Yokota H, Shimizu W, Asai K. Clinical Characteristics and Prognosis of Life-Threatening Acute Myocardial Infarction in Patients Transferred to an Emergency Medical Care Center. Int Heart J 2023; 64:164-171. [PMID: 37005312 DOI: 10.1536/ihj.22-654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Patients with acute myocardial infarction (AMI) triaged as life-threatening are transferred to our emergency medical care center (EMCC). However, data on these patients remain limited. We aimed to compare the characteristics and AMI prognosis of patients transferred to our EMCC with those transferred to our cardiovascular intensive care unit (CICU) using whole and propensity-matched cohorts.We analyzed the data of 256 consecutive AMI patients transferred from the scene to our hospital by ambulance between 2014 and 2017. The EMCC and CICU groups comprised 77 and 179 patients, respectively. There were no significant between-group age or sex differences. Patients in the EMCC group had more disease severity score and had the left main trunk identified as the culprit more frequently (12% versus 0.6%, P < 0.001) than those in the CICU group; however, the number of patients with multiple culprit vessels did not differ. The EMCC group had a longer door-to-reperfusion time (75 [60, 109] minutes versus 60 [40, 86] minutes, P< 0.001) and a higher in-hospital mortality (19% versus 4.5%, P < 0.001), especially from non-cardiac causes (10% versus 0.6%, P < 0.001), than the CICU group. However, peak myocardial creatine phosphokinase did not significantly differ between the groups. The EMCC group had a significantly higher 1-year post-discharge mortality than the CICU group (log-rank, P = 0.032); this trend was maintained after propensity score matching, although the difference was not statistically significant (log-rank, P = 0.094).AMI patients transferred to the EMCC exhibited more severe disease and worse overall in-hospital and non-cardiac mortality than those transferred to the CICU.
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Affiliation(s)
- Hideto Sangen
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Tokuhiro Kimura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Noritomo Narita
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kenta Onodera
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Keishi Suzuki
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kosuke Kadooka
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Kenta Takahashi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Toshinori Ko
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hiroshi Hayashi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yusuke Hosokawa
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Koichi Akutsu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo
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Demisse L, Alemayehu B, Addissie A, Azazh A, Gary R. Knowledge, attitudes and beliefs about acute coronary syndrome among patients diagnosed with acute coronary syndrome, Addis Ababa, Ethiopia. BMC Cardiovasc Disord 2022; 22:444. [PMID: 36241970 PMCID: PMC9563121 DOI: 10.1186/s12872-022-02893-2] [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: 03/09/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Acute coronary syndrome (ACS) morbidity and mortality are rising in low- and middle-income countries, including Ethiopia. The shift in health-care resources from communicable diseases to chronic conditions has created formidable health-care challenges. Objective The objective of this study was to examine the knowledge, attitudes and beliefs among ACS patients. Methods A cross-sectional design was used to enroll participants admitted to one of 3 emergency units in Addis Ababa, Ethiopia. Knowledge, attitudes and beliefs about ACS was measured using modified ACS response index questionaries. Results Participant’s (N = 330) mean age was 57.9 ± 14.1, majority male (n = 219, 66.36%). Half of the study participants have inadequate Knowledge (n = 147, 44.6%), unfavorable attitudes (n = 152, 46%), and belief (n = 153, 46.4%) about ACS symptoms even after being diagnosed and treated in the emergency unit. The most frequently recognized ACS symptoms were chest discomfort (n = 274, 83%), fatigue (n = 267, 80.9%) and chest pain (n = 266, 80.6%) while Jaw pain (n = 101, 30%) neck pain (n = 146,44.2%), were less often recognized. Nearly two thirds of the participants (n = 214, 65%) would not prefer to use emergency medical services (EMS) to come to the hospital. Factors associated with adequate knowledge were age < 45 (AOR = 2.16, CI (1.1–4.0) p = 0.014), and female sex (AOR = 2.7, CI (1.5–4.4) p = 0.001) and diabetics (AOR = 1.9, (1.18–3.0) p = 0.008). Meanwhile, lack of formal education (AOR = 6.7, CI (3.1–14) p < 0.001) and unemployment (AOR = 2.0, CI (1.1–3.8) p = 0.021) were associated with unfavorable attitude. In addition, lack of social support (AOR = 1.9, (1.17–3.0) p = 0.009) and unfavorable attitude (AOR = 2.1, CI (1.3–3.4) p = 0.001) were significantly associated with unfavorable belief. Conclusion Despite receiving treatment for ACS in an emergency unit, roughly half of participants did not have adequate knowledge, favorable attitude and belief towards ACS. This elucidates there is significant communication gap between the health care providers and patients. The study findings stipulate there is a need to provide health awareness campaigns using different media outlet with special attention to the uneducated and unemployed groups. Furthermore, most participants were less likely to utilize emergency medical service, which should be further investigated and addressed.
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Affiliation(s)
- Lemlem Demisse
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Bekele Alemayehu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Beza L, Alemayehu B, Addissie A, Azazh A, Gary R. Treatment Seeking Behaviors and Associated Factors among Patients Experiencing Acute Coronary Syndrome Using Health Belief Model in Addis Ababa, Ethiopia. Ethiop J Health Sci 2022; 32:781-790. [PMID: 35950066 PMCID: PMC9341033 DOI: 10.4314/ejhs.v32i4.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute coronary syndrome (ACS) is a life-threatening condition. The mortality rate will be reduced if immediate treatment is provided. Patients' awareness of ACS is limited, so they do not seek help as quite often as they should. The level of treatment seeking behavior and associated factors among ACS patients admitted to three hospitals in Addis Ababa, Ethiopia, were assessed using a health belief model. Methods A cross-sectional study was conducted among 330 ACS patients from November 2019 to December 2020. Sociodemographic and clinical variables data were extracted using pre-tested checklist. The outcome and other variables data were collected using the checklist and structured questionnaire. The data were entered into Epi-data 3.1 and exported to STATA 17.1 for analysis. Descriptive statistics relevant to the variable was performed. A multivariable logistic regression was used to identify factors associated with treatment seeking behavior. Results This study revealed that the mean time from symptom onset to arrival at the emergency unit (EU) was 24 ± 19.5 hours, slightly < half of the participants (n=149, 45.1 %) had adequate treatment seeking behavior. Perceived threat (AOR=1.03,95% CI:1.01–1.06, p=0.002), perceived benefits (AOR=1.09, 95%CI: 1.02–1.0, p≤0.001), self-efficacy (AOR=1.16, 95% CI :1.01- 1.22, p≤0.001), education (AOR=2.2,95%CI:1.31–3.9, p≤0.01) self-autonomy (AOR=3.1,95%CI:1.82–5.4, p<.001) and no depression (AOR=1.9,95%CI:1.1–3.3, p≤0.05) were found to have significantly association with adequate treatment seeking behavior. Conclusion This study indicates, less than half of ACS patients had adequate treatment seeking behavior. Thus, context-specific behavioral interventions, along with public awareness campaigns about ACS, should be implemented.
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Affiliation(s)
- Lemlem Beza
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekele Alemayehu
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Kyuno T, Otsuka K, Kobayashi M, Yoshida E, Sato K, Kawagishi R, Kono T, Chiba T, Kimura T, Yonezawa H, Funato O, Takagane A. Time limit to rescue intestine with viability at risk caused by blood flow disruption in patients presenting with acute abdomen. Surg Today 2022; 52:1627-1633. [PMID: 35338428 PMCID: PMC9592629 DOI: 10.1007/s00595-022-02495-7] [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: 10/28/2021] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
Purpose Early management is crucial for acute intestinal blood flow disorders; however, no published study has identified criteria for the time limit for blood flow resumption. This study specifically examines the time factors for avoiding intestinal resection. Methods The subjects of this retrospective cohort study were 125 consecutive patients who underwent emergency surgery for a confirmed diagnosis of intestinal strangulation (n = 86), incarceration (n = 27), or volvulus (n = 12), between January 2015 and March 2021. Intestinal resection was performed when intestinal irreversible changes had occurred even after ischemia was relieved surgically. We analyzed the relationship between the time from computed tomography (CT) imaging to the start of surgery (C-S time) and intestinal resection using the Kaplan–Meier method and calculated the estimated intestinal rescue rate. Patient background factors affecting intestinal resection were also examined. Results The time limit for achieving 80% intestinal rescue rate was 200 min in C-S time, and when this exceeded 300 min, the intestinal rescue rate dropped to less than 50%. Multivariate analysis identified the APACHE II score as a significant influencing factor. Conclusion A rapid transition from early diagnosis to early surgery is critical for patients with acute abdomen originating from intestinal blood flow disorders. The times from presentation at the hospital to surgery should be reduced further, especially for severe cases.
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Affiliation(s)
- Takuro Kyuno
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan.
| | - Kanki Otsuka
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Makoto Kobayashi
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Eiji Yoshida
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Kei Sato
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Ryoko Kawagishi
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Tsuyoshi Kono
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Takehiro Chiba
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Toshimoto Kimura
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Hitoshi Yonezawa
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Osamu Funato
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
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Takaoka Y, Hamatani Y, Shibata T, Oishi S, Utsunomiya A, Kawai F, Komiyama N, Mizuno A. Quality indicators of palliative care for cardiovascular intensive care. J Intensive Care 2022; 10:15. [PMID: 35287745 PMCID: PMC8922808 DOI: 10.1186/s40560-022-00607-6] [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: 11/29/2021] [Accepted: 03/01/2022] [Indexed: 01/11/2023] Open
Abstract
Healthcare providers working for cardiovascular intensive care often face challenges and they play an essential role in palliative care and end-of-life care because of the high mortality rates in the cardiac intensive care unit. Unfortunately, there are several barriers to integrating palliative care, cardiovascular care, and intensive care. The main reasons are as follows: cardiovascular disease-specific trajectories differ from cancer, there is uncertainty associated with treatments and diagnoses, aggressive treatments are necessary for symptom relief, and there is ethical dilemma regarding withholding and withdrawal of life-sustaining therapy. Quality indicators that can iterate the minimum requirements of each medical discipline could be used to overcome these barriers and effectively practice palliative care in cardiovascular intensive care. Unfortunately, there are no specific quality indicators for palliative care in cardiovascular intensive care. A few indicators and their domains are useful for understanding current palliative care in cardiovascular intensive care. Among them, several domains, such as symptom palliation, patient- and family-centered decision-making, continuity of care, and support for health care providers that are particularly important in cardiovascular intensive care. Historically, the motivation for using quality indicators is to summarize mechanisms for external accountability and verification, and formative mechanisms for quality improvement. Practically, when using quality indicators, it is necessary to check structural indicators in each healthcare service line, screen palliative care at the first visit, and integrate palliative care teams with other professionals. Finally, we would like to state that quality indicators in cardiovascular intensive care could be useful as an educational tool for practicing palliative care, understanding the minimum requirements, and as a basic structure for future discussions.
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Affiliation(s)
- Yoshimitsu Takaoka
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Shogo Oishi
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Akemi Utsunomiya
- Department of Critical Care Nursing, Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fujimi Kawai
- St. Luke's International University Library, Tokyo, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan. .,Penn Medicine Nudge Unit, University of Pennsylvania Philadelphia, Philadelphia, PA, USA. .,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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9
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Kyuno E, Iso Y, Tsujiuchi M, Maeda A, Miyazawa R, Kowaita H, Kitai H, Sato T, Ebato M, Sambe T, Suzuki H. Impact of Exercise-Based Cardiac Rehabilitation on the Mid-Term Outcomes of Patients After Acute Myocardial Infarction Treated With Current Acute-Phase Management and Optimal Medical Therapy. Heart Lung Circ 2021; 30:1320-1328. [PMID: 33867276 DOI: 10.1016/j.hlc.2021.03.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/17/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early reported beneficial effects of cardiac rehabilitation (CR) have recently been disputed. The present study aimed to investigate the clinical impact of CR on the mid-term outcomes of patients following ST-segment elevation myocardial infarction (STEMI) treated with currently available management. METHODS This study reviewed 145 consecutive patients who underwent primary coronary intervention and were discharged without any disability after STEMI during 2013-2015. RESULTS Among the patients, 66 (45.5%) completed an outpatient CR program (CR group) and 79 were their non-CR counterparts or patients who dropped out of the program (N-D group). There were no between-group differences in patient demographics and clinical profiles, including door-to-balloon times and prescriptions. A total of 27 patients developed major adverse cardiac and cerebrovascular events (MACCE) during follow-up. The MACCE-free survival rates were 88% and 76% in the CR and N-D groups, respectively (log-rank, p=0.04). Cox proportional analysis demonstrated that inclusion in the N-D group was a significant predictor of MACCEs (HR, 2.36; 95% CI, 1.07-5.74; p=0.03). In the CR group, peak oxygen consumption and ventilatory efficiency determined by cardiopulmonary exercise testing significantly improved after the program (p<0.01). CONCLUSIONS The impact of CR on the mid-term prognosis of patients with STEMI, even in the current myocardial infarction management era, was beneficial.
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Affiliation(s)
- Etsushi Kyuno
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan; Showa University Research Institute for Sport and Exercise Sciences, Yokohama, Japan
| | - Yoshitaka Iso
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan; Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Miki Tsujiuchi
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Atsuo Maeda
- Department of Emergency and Disaster Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Ryo Miyazawa
- Center for Rehabilitation, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Hitoshi Kowaita
- Center for Rehabilitation, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Hitomi Kitai
- Showa University Research Institute for Sport and Exercise Sciences, Yokohama, Japan
| | - Tokutada Sato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Takeyuki Sambe
- Showa University Research Institute for Sport and Exercise Sciences, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
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10
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Custodio-Sánchez P, Miranda D, Murillo L. [Impact of the COVID-19 pandemic on ST- elevation myocardial infarction care in Peru]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2020; 1:67-74. [PMID: 38572337 PMCID: PMC10986344 DOI: 10.47487/apcyccv.v1i2.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 04/05/2024]
Abstract
Purpose To compare the number of admissions, clinical features and therapeutic outcomes of patients treated for acute ST-segment elevation myocardial infarction (STEMI), before and after the COVID-19 pandemic state of emergency in Peru. Methods Observational analytical study of retrospective cohorts, derivated from the PEruvian Registry of ST-segment Elevation Myocardial Infarction II (PERSTEMI II). We compared the patients treated for STEMI, between 45 days before and during the first 45 days of the COVID-19 state of emergency in Peru. Results During the first 45 days of the COVID-19 state of emergency, the team found a 59% decrease on the number of admissions for STEMI. There was a larger proportion of patients with high blood pressure and dyslipidemia. We noticed a decreasing trend in the access to reperfusion therapies (73% vs. 66.6%); the fibrinolysis was the most commonly used therapy. The most frequent reason for no reperfusion was the late onset >24 hours (41.7%, p=0.004). There was a trend of time reduction to first medical contact and less ischemia time to reperfusion. A lower incidence of post-infarction heart failure was registered. The mortality was similar in both groups (3.4% vs. 2.7%). Conclusions COVID-19 pandemic in Peru has generated a significant reduction of STEMI admissions and a trend in less use of reperfusion therapies. The late onset of patients was the most common reason of not reperfusion.
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Affiliation(s)
- Piero Custodio-Sánchez
- Servicio de Cardiología. Unidad de Cardiología Intervencionista. Hospital Nacional Almanzor Aguinaga Asenjo Essalud, Chiclayo, Perú. Servicio de CardiologíaUnidad de Cardiología IntervencionistaHospital Nacional Almanzor Aguinaga Asenjo EssaludChiclayoPerú
| | - David Miranda
- Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - Luis Murillo
- Médico residente de Cardiología. Instituto Nacional Cardiovascular INCOR. Lima, Perú.Médico residente de CardiologíaInstituto Nacional Cardiovascular INCORLimaPerú
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Mirzaei S, Steffen A, Vuckovic K, Ryan C, Bronas UG, Zegre-Hemsey J, DeVon HA. The association between symptom onset characteristics and prehospital delay in women and men with acute coronary syndrome. Eur J Cardiovasc Nurs 2019; 19:142-154. [PMID: 31510786 DOI: 10.1177/1474515119871734] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A decision to delay seeking treatment for symptoms of acute coronary syndrome increases the risk of serious complications, disability, and death. AIMS The purpose of this study was to determine if there was an association between gradual vs abrupt symptom onset and prehospital delay for patients with acute coronary syndrome and to examine the relationship between activities at symptom onset and gradual vs abrupt symptom onset. METHODS This was a secondary analysis of a large prospective multi-center study. Altogether, 474 patients presenting to the emergency department with symptoms of acute coronary syndrome were included in the study. Symptom characteristics, activity at symptom onset, and prehospital delay were measured with the ACS Patient Questionnaire. RESULTS Median prehospital delay time was four hours. Being uninsured (β=0.120, p=0.031) and having a gradual onset of symptoms (β=0.138, p=0.003) were associated with longer delay. A diagnosis of ST-elevation myocardial infarction (β=-0.205, p=0.001) and arrival by ambulance (β=-0.317, p<0.001) were associated with shorter delay. Delay times were shorter for patients who experienced an abrupt vs gradual symptom onset (2.57 h vs 8 h, p<0.001). Among men with an abrupt onset of symptoms and a ST-elevation myocardial infarction diagnosis, 54% reported that symptoms were triggered by exertion (p=0.046). CONCLUSION Patients should be counselled that a gradual onset of symptoms for potential acute coronary syndrome is an emergency and that they should call 911. Men with ischemic heart disease or with multiple risk factors should be cautioned that symptom onset following exertion may represent acute coronary syndrome.
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Affiliation(s)
- Sahereh Mirzaei
- Department of Biobehavioral Health Science, University of Illinois, USA
| | - Alana Steffen
- Department of Health Systems Science, University of Illinois at Chicago, USA
| | - Karen Vuckovic
- Department of Biobehavioral Health Science, University of Illinois, USA
| | - Catherine Ryan
- Department of Biobehavioral Health Science, University of Illinois, USA
| | - Ulf G Bronas
- Department of Biobehavioral Health Science, University of Illinois, USA
| | | | - Holli A DeVon
- Department of Biobehavioral Health Science, University of Illinois, USA
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