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Beckmann C, Foster-Witassek F, Brutsche M, Maeder MT, Eberli F, Roffi M, Pedrazzini G, Radovanovic D, Rickli H. Treatment and outcomes of patients with chronic lung disease and acute myocardial infarction: Insights from the nationwide AMIS plus registry. Eur J Clin Invest 2024; 54:e14193. [PMID: 38481088 DOI: 10.1111/eci.14193] [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: 11/12/2023] [Revised: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Limited data are available on patients with chronic lung disease (CLD) presenting with acute myocardial infarction (AMI). We aimed to analyse baseline characteristics, treatment and outcome of those patients enrolled in the Swiss nationwide prospective AMIS Plus registry. METHODS All AMI patients enrolled between January 2002 and December 2021 with data on CLD, as defined in the Charlson Comorbidity Index, were included. The primary endpoints were in-hospital mortality and major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, reinfarction and cerebrovascular events. Baseline characteristics, in-hospital treatments and outcomes were analysed using descriptive statistics and logistic regression. RESULTS Among 53,680 AMI patients enrolled during this time, 5.8% had CLD. Compared with patients without CLD, CLD patients presented more frequently with non-ST-elevation myocardial infarction (MI) and type 2 MI (12.8% vs. 6.5%, p < 0.001). With respect to treatment, CLD patients were less likely to receive P2Y12 inhibitors (p < 0.001) and less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p < 0.001). In-hospital mortality declined in AMI patients with CLD over time (from 12% in 2002 to 7.3% in 2021). Multivariable regression analysis showed that CLD was an independent predictor for MACCE (adjusted OR was 1.28 [95% CI 1.07-1.52], p = 0.006). CONCLUSION Patients with CLD and AMI were less likely to receive evidence-based pharmacologic treatments, coronary revascularization and had a higher incidence of MACCE during their hospital stay compared to those without CLD. Over 20 years, in-hospital mortality was significantly reduced in AMI patients, especially in those with CLD.
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Affiliation(s)
- C Beckmann
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - F Foster-Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Brutsche
- Lung Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - M T Maeder
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F Eberli
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - M Roffi
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - G Pedrazzini
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - D Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - H Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Chiang CH, Jiang YC, Hung WT, Kuo SH, Hsia K, Wang CL, Fu YJ, Lin KC, Lin SC, Cheng CC, Huang WC. Impact of medications on outcomes in patients with acute myocardial infarction and chronic obstructive pulmonary disease: A nationwide cohort study. J Chin Med Assoc 2023; 86:183-190. [PMID: 36652566 DOI: 10.1097/jcma.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Various inhaled bronchodilators have been associated with cardiovascular safety concerns. This study aimed to investigate the long-term impact of chronic obstructive pulmonary disease (COPD) and the safety of COPD medications in patients after their first acute myocardial infarction (AMI). METHODS This nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Patients hospitalized between 2000 and 2012 with a primary diagnosis of first AMI were included and divided into three cohorts (AMI, ST-elevation myocardial infarction [STEMI], and non-STEMI [NSTEMI]). Each cohort was propensity score matched (1:1) with patients without COPD. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) with 95% CIs. RESULTS A total of 186 112 patients with AMI were enrolled, and COPD was diagnosed in 13 065 (7%) patients. Kaplan-Meier curves showed that patients with COPD had a higher mortality risk than those without COPD in all cohorts (AMI, STEMI, and NSTEMI). The HR of mortality in AMI, STEMI, and NSTEMI patients with COPD was 1.12 (95% CI, 1.09-1.14), 1.20 (95% CI, 1.14-1.25), and 1.07 (95% CI, 1.04-1.10), respectively. Short-acting inhaled bronchodilators and corticosteroids increased mortality risk in all three cohorts. However, long-acting inhaled bronchodilators reduced mortality risk in patients with AMI (long-acting beta-agonist [LABA]: HR, 0.87; 95% CI, 0.81-0.94; long-acting muscarinic antagonist [LAMA]: HR, 0.82; 95% CI, 0.69-0.96) and NSTEMI (LABA: HR, 0.89; 95% CI, 0.83-0.97; LAMA: HR, 0.80; 95% CI, 0.68-0.96). CONCLUSION This study demonstrated that AMI patients with COPD had higher mortality rates than those without COPD. Using inhaled short-acting bronchodilators and corticosteroids reduced survival, whereas long-acting bronchodilators provided survival benefits in AMI and NSTEMI patients. Therefore, appropriate COPD medication for acute AMI is crucial.
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Affiliation(s)
- Cheng-Hung Chiang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
| | - You-Cheng Jiang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wan-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Shu-Hung Kuo
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Kai Hsia
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Lin Wang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Su-Chiang Lin
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
| | - Wei-Chun Huang
- School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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3
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Krishnan JK, Rajan M, Banerjee S, Mallya SG, Han MK, Mannino DM, Martinez FJ, Safford MM. Race and Sex Differences in Mortality in Individuals with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2022; 19:1661-1668. [PMID: 35657680 PMCID: PMC9528745 DOI: 10.1513/annalsats.202112-1346oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/31/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale: Despite differences in chronic obstructive pulmonary disease (COPD) comorbidities, race- and sex-based differences in all-cause mortality and cause-specific mortality are not well described. Objectives: To examine mortality differences in COPD by race-sex and underlying mechanisms. Methods: Medicare claims were used to identify COPD among REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort participants. Mortality rates were calculated using adjudicated causes of death. Hazard ratios (HRs) for mortality comparing race-sex groups were modeled with Cox proportional hazards regression. Results: In the 2,148-member COPD subcohort, 49% were women, and 34% were Black individuals; 1,326 deaths occurred over a median 7.5 years (interquartile range, 3.9-10.5 yr) follow-up. All-cause mortality per 1,000 person-years comparing Black versus White men was 101.1 (95% confidence interval [CI], 88.3-115.8) versus 93.9 (95% CI, 86.3-102.3; P = 0.99); comparing Black versus White women, all-cause mortality per 1,000 person-years was 74.2 (95% CI, 65.0-84.8) versus 70.6 (95% CI, 63.5-78.5; P = 0.99). Cardiovascular disease (CVD) was the leading cause-specific mortality among all race-sex groups. HR for CVD and chronic lung disease mortality were nonsignificant comparing Black versus White men. HR for CVD death was higher in Black compared with White women (HR, 1.44; 95% CI, 1.06-1.95), whereas chronic lung disease death was lower (HR, 0.44; 95% CI, 0.25-0.77). These differences were attributable to higher CVD risk factor burden among Black women. Conclusions: In the REGARDS COPD cohort, there were no race-sex differences in all-cause mortality. CVD was the most common cause of death for all race-sex groups with COPD. Black women with COPD had a higher risk of CVD-related mortality than White women. CVD comorbidity management, especially among Black individuals, may improve mortality outcomes.
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Affiliation(s)
| | - Mangala Rajan
- Division of General Internal Medicine, Weill Cornell Department of Medicine, New York, New York
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Sonal G. Mallya
- Division of General Internal Medicine, Weill Cornell Department of Medicine, New York, New York
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan; and
| | - David M. Mannino
- Department of Preventative Medicine and Environmental Health, University of Kentucky, Lexington, Kentucky
| | | | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Department of Medicine, New York, New York
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De Luca G, Nardin M, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Lee MKY, Arifa Juzar D, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Martínez-Luengas IL, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo S, Ordoñez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Saint-Joy V, Pessah G, Tuccillo A, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Verdoia M. Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry. Respir Res 2022; 23:207. [PMID: 35971173 PMCID: PMC9376902 DOI: 10.1186/s12931-022-02128-0] [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: 01/08/2022] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020).
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy. .,University of Sassari, Sassari, Italy.
| | - Matteo Nardin
- Third Medicine Division, ASST Spedali Civili, Brescia, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- Medical Faculty, University Clinic for Cardiology, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, Bucharest, Romania
| | - Gerard Roura Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti Latina, Latina, Italy
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Yau Ma Tei, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio" Bolzano, Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Arpad Lux
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University, İstanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero-Universitaria Ospedali Riuniti Trieste, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta, Pragal, Almada, Portugal
| | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France
| | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Division of Cardiology Clinical and Experimental Interventional Cardiology, University of Saarland, Saarbrücken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO-Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Greece
| | - Ylitalo Antti
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | | | | | | | | | - Carlos E Uribe
- Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria"Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Frankie Chor-Cheung Tam
- Department of Cardiology, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita, Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padua, Italy
| | - Guido Parodi
- Department of Cardiology, ASL 4 Liguria, Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Ponderano, Italy
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Effects of chronic obstructive pulmonary disease on long-term prognosis of patients with coronary heart disease post-percutaneous coronary intervention. J Geriatr Cardiol 2022; 19:428-434. [PMID: 35845153 PMCID: PMC9248278 DOI: 10.11909/j.issn.1671-5411.2022.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases are often comorbid conditions, their co-occurrence yields worse outcomes than either condition alone. This study aimed to investigate COPD impacts on the five-year prognosis of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). METHODS Patients with CHD who underwent PCI in 2013 were recruited, and divided into COPD group and non-COPD group. Adverse events occurring among those groups were recorded during the five-year follow-up period after PCI, including all-cause death and cardiogenic death, myocardial infarction, repeated revascularization, as well as stroke and bleeding events. Major adverse cardiac and cerebral events were a composite of all-cause death, myocardial infarction, repeated revascularization and stroke. RESULTS A total of 9843 patients were consecutively enrolled, of which 229 patients (2.3%) had COPD. Compared to non-COPD patients, COPD patients were older, along with poorer estimated glomerular filtration rate and lower left ventricular ejection fraction. Five-year follow-up results showed that incidences of all-cause death and cardiogenic death, as well as major adverse cardiac and cerebral events, for the COPD group were significantly higher than for non-COPD group (10.5% vs. 3.9%, 7.4% vs. 2.3%, and 30.1% vs. 22.6%, respectively). COPD was found under multivariate Cox regression analysis, adjusted for confounding factors, to be an independent predictor of all-cause death [odds ratio (OR) = 1.76, 95% CI: 1.15-2.70, P = 0.009] and cardiogenic death (OR = 2.02, 95% CI: 1.21-3.39, P = 0.007). CONCLUSIONS COPD is an independent predictive factor for clinical mortality, in which CHD patients with COPD are associated with worse prognosis than CHD patients with non-COPD.
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Rasmussen DB, Bodtger U, Lamberts M, Nicolaisen SK, Sessa M, Capuano A, Torp-Pedersen C, Gislason G, Lange P, Jensen MT. Beta-blocker, aspirin, and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease: a nationwide analysis from 1995 to 2015 in Denmark. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:23-31. [PMID: 30608575 DOI: 10.1093/ehjqcco/qcy063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/02/2019] [Indexed: 11/15/2022]
Abstract
AIMS To determine whether beta-blockers, aspirin, and statins are underutilized after first-time myocardial infarction (MI) in patients with chronic obstructive pulmonary disease (COPD) compared with patients without COPD. Further, to determine temporal trends and risk factors for non-use. METHODS AND RESULTS Using Danish nationwide registers, we performed a cross-sectional study investigating the utilization of beta-blockers, aspirin, and statins after hospitalization for first-time MI among patients with and without COPD from 1995 to 2015. Risk factors for non-use were examined in multivariable logistic regression models. During 21 years of study, 140 278 patients were included, hereof 13 496 (9.6%) with COPD. Patients with COPD were less likely to use beta-blockers (53.2% vs. 76.2%, P < 0.001), aspirin (73.9% vs. 78.8%, P < 0.001), and statins (53.5% vs. 61.9%, P < 0.001). Medication usage increased during the study period but in multivariable analyses, COPD remained a significant predictor for non-use: odds ratio (95% confidence interval) for non-use of beta-blockers 1.86 (1.76-1.97); aspirin 1.24 (1.16-1.32); statins 1.50 (1.41-1.59). Analyses stratified by ST-segment elevation myocardial infarction (STEMI) and non-STEMI showed similar undertreatment of COPD patients. Risk factors for non-use of beta-blockers in COPD included increasing age, female sex, and increasing severity of COPD (frequent exacerbations, use of multiple inhaled medications, and low lung function). Similar findings were demonstrated for aspirin and statins. CONCLUSION Beta-blockers, and to a lesser extent aspirin and statins, were systematically underutilized by patients with COPD following hospitalization for MI despite an overall increase in the utilization over time. Increasing severity of COPD was a risk factor for non-use of the medications.
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Affiliation(s)
- Daniel Bech Rasmussen
- Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Ringstedgade 61, 4700 Naestved, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 2900, Hellerup, Denmark.,Department of Regional Health Research, University of Southern Denmark, J. B. Winsloews Vej 5000, Odense, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Ringstedgade 61, 4700 Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, J. B. Winsloews Vej 5000, Odense, Denmark
| | - Morten Lamberts
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 2900, Hellerup, Denmark.,Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 2100, Copenhagen, Denmark
| | - Sia Kromann Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 8200, Aarhus, Denmark
| | - Maurizio Sessa
- Department of Experimental Medicine, Section of Pharmacology 'L. Donatelli', University of Campania 'L. Vanvitelli', Via Santa Maria Di Costantinopoli 80138, Naples, Italy.,Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2100, Copenhagen, Denmark
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology 'L. Donatelli', University of Campania 'L. Vanvitelli', Via Santa Maria Di Costantinopoli 80138, Naples, Italy
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Hobrovej 9000, Aalborg, Denmark.,Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 9220, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 2900, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 2200, Copenhagen, Denmark.,Department of Health and Social Context, The National Institute of Public Health, University of Southern Denmark, Studiestraede 1455, Copenhagen, Denmark.,Department of Research, The Danish Heart Foundation, Vognmagergade 1120, Copenhagen, Denmark
| | - Peter Lange
- Respiratory Section, Medical Department O, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 2730, Herlev, Denmark.,Section of Social Medicine, Department of Public Health, University of Copenhagen, Oester Farimagsgade 1014, Copenhagen, Denmark
| | - Magnus Thorsten Jensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 2900, Hellerup, Denmark.,Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 2100, Copenhagen, Denmark
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7
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de-Miguel-Diez J, Jiménez-García R, Hernandez-Barrera V, Ji Z, de Miguel-Yanes JM, López-Herranz M, López-de-Andrés A. Sex Differences in the Effects of COPD on Incidence and Outcomes of Patients Hospitalized with ST and Non-ST Elevation Myocardial Infarction: A Population-Based Matched-Pair Analysis in Spain (2016-2018). J Clin Med 2021; 10:jcm10040652. [PMID: 33567687 PMCID: PMC7914459 DOI: 10.3390/jcm10040652] [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: 01/14/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
We aimed to compare the incidence, clinical characteristics, and outcomes of patients admitted with myocardial infarction (MI), whether ST elevation MI (STEMI) or non-ST elevation MI (NSTEMI), according to the presence of chronic obstructive pulmonary disease (COPD), and to identify variables associated with in-hospital mortality (IHM). We selected all patients with MI (aged ≥40 years) included in the Spanish National Hospital Discharge Database (2016–2018). We matched each patient suffering COPD with a non-COPD patient with identical age, sex, type of MI, and year of hospitalization. We identified 109,759 men and 44,589 women with MI. The MI incidence was higher in COPD patients (incident rate ratio (IRR) 1.32; 95% confidence interval (CI) 1.29–1.35). Men with COPD had higher incidence of STEMI and NSTEMI than women with COPD. After matching, COPD men had a higher IHM than non-COPD men, but no differences were found among women. The probability of dying was higher among COPD men with STEMI in comparison with NSTEMI (odds ratio (OR) 2.33; 95% CI 1.96–2.77), with this risk being higher among COPD women (OR 2.63; 95% CI 1.75–3.95). Suffering COPD increased the IHM after an MI in men (OR 1.14; 95% CI 1.03–1.27), but no differences were found in women. COPD women had a higher IHM than men (OR 1.19; 95% CI 1.01–1.39). We conclude that MI incidence was higher in COPD patients. IHM was higher in COPD men than in those without COPD, but no differences were found among women. Among COPD patients, STEMI was more lethal than NSTEMI. Suffering COPD increased the IHM after MI among men. Women with COPD had a significantly higher probability of dying in the hospital than COPD men.
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Affiliation(s)
- Javier de-Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.d.-M.-D.); (Z.J.)
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-394-1521
| | - Valentín Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | - Zichen Ji
- Pneumology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.d.-M.-D.); (Z.J.)
| | | | - Marta López-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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8
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Yadegarfar ME, Gale CP, Dondo TB, Wilkinson CG, Cowie MR, Hall M. Association of treatments for acute myocardial infarction and survival for seven common comorbidity states: a nationwide cohort study. BMC Med 2020; 18:231. [PMID: 32829713 PMCID: PMC7444071 DOI: 10.1186/s12916-020-01689-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/29/2020] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Comorbidity is common and has a substantial negative impact on the prognosis of patients with acute myocardial infarction (AMI). Whilst receipt of guideline-indicated treatment for AMI is associated with improved prognosis, the extent to which comorbidities influence treatment provision its efficacy is unknown. Therefore, we investigated the association between treatment provision for AMI and survival for seven common comorbidities. METHODS We used data of 693,388 AMI patients recorded in the Myocardial Ischaemia National Audit Project (MINAP), 2003-2013. We investigated the association between comorbidities and receipt of optimal care for AMI (receipt of all eligible guideline-indicated treatments), and the effect of receipt of optimal care for comorbid AMI patients on long-term survival using flexible parametric survival models. RESULTS A total of 412,809 [59.5%] patients with AMI had at least one comorbidity, including hypertension (302,388 [48.7%]), diabetes (122,228 [19.4%]), chronic obstructive pulmonary disease (COPD, 89,221 [14.9%]), cerebrovascular disease (51,883 [8.6%]), chronic heart failure (33,813 [5.6%]), chronic renal failure (31,029 [5.0%]) and peripheral vascular disease (27,627 [4.6%]). Receipt of optimal care was associated with greatest survival benefit for patients without comorbidities (HR 0.53, 95% CI 0.51-0.56) followed by patients with hypertension (HR 0.60, 95% CI 0.58-0.62), diabetes (HR 0.83, 95% CI 0.80-0.87), peripheral vascular disease (HR 0.85, 95% CI 0.79-0.91), renal failure (HR 0.89, 95% CI 0.84-0.94) and COPD (HR 0.90, 95% CI 0.87-0.94). For patients with heart failure and cerebrovascular disease, optimal care for AMI was not associated with improved survival. CONCLUSIONS Overall, guideline-indicated care was associated with improved long-term survival. However, this was not the case in AMI patients with concomitant heart failure or cerebrovascular disease. There is therefore a need for novel treatments to improve outcomes for AMI patients with pre-existing heart failure or cerebrovascular disease.
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Affiliation(s)
- Mohammad E Yadegarfar
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, LS2 9NL, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, LS2 9NL, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tatendashe B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, LS2 9NL, UK
| | - Chris G Wilkinson
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, LS2 9NL, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Martin R Cowie
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. .,Leeds Institute for Data Analytics, University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, LS2 9NL, UK.
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9
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Goedemans L, Bax JJ, Delgado V. COPD and acute myocardial infarction. Eur Respir Rev 2020; 29:29/156/190139. [PMID: 32581139 DOI: 10.1183/16000617.0139-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and AMI. The prevalence of COPD amongst AMI populations ranges from 7% to 30%, which is possibly even an underestimation due to underdiagnoses of COPD in general. Following the acute event, patients with COPD have an increased risk of mortality, heart failure and arrhythmias during follow-up. Adequate risk stratification can be performed using various imaging techniques, evaluating cardiac size and function after AMI. Conventional imaging techniques such as echocardiography and cardiac magnetic resonance imaging have already indicated impaired cardiac function in patients with COPD without known cardiovascular disease. Advanced imaging techniques such as speckle-tracking echocardiography and T1 mapping could provide more insight into cardiac structure and function after AMI and have proven to be of prognostic value. Future research is required to better understand the impact of AMI on patients with COPD in order to provide effective secondary prevention. The present article summarises the current knowledge on the pathophysiologic factors involved in the interaction between COPD and AMI, the prevalence and outcomes of AMI in patients with COPD and the role of imaging in the acute phase and risk stratification after AMI in patients with COPD.
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Affiliation(s)
- Laurien Goedemans
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Dept of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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10
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Li P, Lu X, Kranis M, Wu F, Teng C, Cai P, Hashmath Z, Wang B. The association between anxiety disorders and in-hospital outcomes in patients with myocardial infarction. Clin Cardiol 2020; 43:622-629. [PMID: 32187718 PMCID: PMC7298986 DOI: 10.1002/clc.23358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anxiety disorders are prevalent in patients with myocardial infarction (MI), but the effects of anxiety disorders on in-hospital outcomes within MI patients have not been well studied. HYPOTHESIS To examine the effects of concurrent anxiety disorders on in-hospital outcomes in MI patients. METHODS We conducted a retrospective cohort study in patients with a principal diagnosis of MI with and without anxiety disorders in the National Inpatient Sample 2016. A total of 129 305 primary hospitalizations for acute MI, 35 237 with ST-segment elevation myocardial infarction (STEMI), and 94 068 with non-ST elevation myocardial infarction (NSTEMI) were identified. Of these, 13 112 (10.1%) had anxiety (7.9% in STEMI and 11.0% in NSTEMI). We compared outcomes of anxiety and nonanxiety groups after propensity score matching for the patient and hospital demographics and relevant comorbidities. RESULTS After propensity score matching, the anxiety group had a lower incidence of in-hospital mortality (3.0% vs 4.4%, P < .001), cardiac arrest (2.1% vs 2.8%, P < .001), cardiogenic shock (4.9% vs 5.6%, P = .007), and ventricular arrhythmia (6.7% vs 7.9%, P < .001) than the nonanxiety group. In the NSTEMI subgroup, the anxiety group had significantly lower rates of in-hospital mortality (2.3% vs 3.5%, P < .001), cardiac arrest (1.1% vs 1.5%, P = .008), and cardiogenic shock (2.8% vs 3.5%, P = .008). In the STEMI subgroup, we found no differences in in-hospital outcomes (all P > .05) between the matched groups. CONCLUSION Although we found that anxiety was associated with better in-hospital outcomes, subgroup analysis revealed that this only applied to patients admitted for NSTEMI instead of STEMI.
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Affiliation(s)
- Pengyang Li
- Department of MedicineSaint Vincent HospitalWorcesterMassachusettsUSA
| | - Xiaojia Lu
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Mark Kranis
- Department of CardiologySaint Vincent HospitalWorcesterMassachusettsUSA
| | - Fangcheng Wu
- Department of MedicineMemorial Hospital WestPembroke PinesFloridaUSA
| | - Catherine Teng
- Department of Medicine, Greenwich HospitalYale New Haven HealthGreenwichConnecticutUSA
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMassachusettsUSA
| | - Zeba Hashmath
- Department of MedicineSaint Vincent HospitalWorcesterMassachusettsUSA
| | - Bin Wang
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
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11
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Alqahtani F, Welle GA, Elsisy MF, Kalra A, Alhajji M, Boubas W, Berzingi C, Alkhouli M. Incidence, Characteristics, and Outcomes of Acute Myocardial Infarction among Patients Admitted with Acute Exacerbation of Chronic Obstructive Lung Disease. COPD 2020; 17:261-268. [PMID: 32366132 DOI: 10.1080/15412555.2020.1757054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The frequency, characteristics and outcomes of acute myocardial infarction (AMI) during exacerbation of chronic obstructive pulmonary disease (COPD) are unknown. Adult patients hospitalized with a principle diagnosis of acute COPD exacerbation were identified using retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2003 to 2016. Patients were stratified into 2-groups with and without a secondary diagnosis of AMI. The study's endpoints were in-hospital morbidity, mortality, and resource utilization. We also assessed the impact of invasive management strategy on the same end-points. We included 6 894 712 hospitalizations, of which 56 515 (0.82%) were complicated with AMIs. Patients with AMI were older, and had higher prevalence of known coronary disease (48.9% vs. 27.4%), atrial fibrillation (23.3% vs. 15.2%), heart failure (47.8% vs. 26.2%), and anemia (20.7% vs. 14.8%) (p < 0.001). Rates of oxygen dependence were similar (16.3% vs. 16.1%, p = 0.24). In 56 486 propensity-matched pairs of patients with and without AMI, mortality was higher in the AMI group (12.1% vs. 2.1%, p < 0.001). Rates of major morbidities, non-home discharge, and cost were all higher in the AMI group. A minority (18.1%) of patients with AMI underwent invasive assessment, and those had lower in-hospital mortality before (4.9% vs. 13.8%) and after (5.0% vs. 10.0%) propensity-score matching (p < 0.001). This lower mortality persisted in a sensitivity analysis accounting for immortal time bias. AMI complicates ∼1% of patients admitted with acute COPD exacerbation, and those have worse outcomes than those without AMI. Invasive management for secondary AMI during acute COPD exacerbation may be associated with improved outcomes but is utilized in <20% of patients.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, University of Kentucky, Lexington, KY, USA
| | - Garrett A Welle
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Mohamed F Elsisy
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Alhajji
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Wafaa Boubas
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Chalak Berzingi
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
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12
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The role of statins in chronic obstructive pulmonary disease: is cardiovascular disease the common denominator? Curr Opin Pulm Med 2020; 25:173-178. [PMID: 30418244 DOI: 10.1097/mcp.0000000000000551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The pleiotropic anti-inflammatory effects of statins that have proven to improve outcomes in cardiovascular disease have also been of interest in the treatment of COPD, a disease with considerable morbidity and little available treatment that improves mortality. In-vitro and animal studies have supported biologic plausibility of statin therapy for lung health and function. Retrospective observational studies in humans have echoed this potential as well but confirmatory data from randomized studies are limited and somewhat disappointing. RECENT FINDINGS Despite discouraging clinical trial results, the possibility remains that statins can help patients with COPD characterized by systemic inflammation. At the same time, increasing recognition of the considerable cardiovascular disease burden and its suboptimal treatment in patients with COPD has also contributed to continued enthusiasm for statin use in COPD. SUMMARY When it comes to defining the role for statins as a disease-modifying therapy, the jury is still out; however, the importance of more careful cardiovascular risk stratification that includes assessing levels of inflammatory markers in patients with COPD and the benefit of statins in those with increased risk is gaining increasing recognition.
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13
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Affiliation(s)
- Shannon W Finks
- From the College of Pharmacy, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis (S.W.F., T.H.S.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa (M.J.R.)
| | - Mark J Rumbak
- From the College of Pharmacy, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis (S.W.F., T.H.S.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa (M.J.R.)
| | - Timothy H Self
- From the College of Pharmacy, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis (S.W.F., T.H.S.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa (M.J.R.)
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14
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Pinner N, Oliver W, Veasey T, Starr J, Eudaley S, Hutchison A, Wargo K. Frequency of β-Blocker Use Following Exacerbations of COPD in Patients with Compelling Indication for Use. South Med J 2019; 112:586-590. [DOI: 10.14423/smj.0000000000001038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Ando T, Adegbala O, Takagi H, Afonso L, Briasoulis A. Early Invasive Versus Ischemia-Guided Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome With Chronic Obstructive Pulmonary Disease: A National Inpatient Sample Analysis. Angiology 2019; 71:372-379. [PMID: 31578083 DOI: 10.1177/0003319719877096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a risk factor for non-ST-segment elevation-acute coronary syndromes (NSTE-ACS). Whether early invasive strategy (EIS) or ischemia-guided strategy (IGS) confers better outcomes in NSTE-ACS with COPD is largely unknown. Nationwide Inpatient Sample database of the United States was queried from 2010 to 2015 to identify NSTE-ACS with and without COPD. Early invasive strategy was defined as coronary angiogram with or without revascularization on admission day 0 or 1, whereas IGS included patients who did not receive EIS. Standardized morbidity ratio weight was used to calculate the adjusted odds ratio. A total of 228 175 NSTE-ACS admissions with COPD were identified of which 34.0% received EIS. In-hospital mortality was lower with EIS in patients with COPD (3.1% vs 5.5%, adjusted odds ratio 0.57, 95% confidence interval 0.50-0.63) compared to IGS, but the magnitude of mortality reduction observed in EIS in patients with COPD was less compared to non-COPD patients (P interaction = .02). Length of stay was shorter (4.2 vs 4.7 days, P < .0001) but the cost was higher (US$23 804 vs US$18 533, P < .0001) in EIS in COPD. Early invasive strategy resulted in lower in-hospital mortality and marginally shorter length of stay but higher hospitalization cost in NSTE-ACS with COPD.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Oluwole Adegbala
- Division of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, USA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Luis Afonso
- Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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16
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Parkin L, Quon J, Sharples K, Barson D, Dummer J. Underuse of beta‐blockers by patients with COPD and co‐morbid acute coronary syndrome: A nationwide follow‐up study in New Zealand. Respirology 2019; 25:173-182. [DOI: 10.1111/resp.13662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/16/2019] [Accepted: 06/27/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Lianne Parkin
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
| | - Joshua Quon
- Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
- Department of Mathematics and StatisticsUniversity of Otago Dunedin New Zealand
| | - David Barson
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
| | - Jack Dummer
- Pharmacoepidemiology Research Network Dunedin New Zealand
- Department of Medicine, Dunedin School of MedicineUniversity of Otago Dunedin New Zealand
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17
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Liu Y, Yao Y, Tang XF, Xu N, Jiang P, Jiang L, Zhao XY, Chen J, Yang YJ, Gao RL, Xu B, Yuan JQ. Evaluation of a novel score for predicting 2-year outcomes in patients with acute coronary syndrome after percutaneous coronary intervention. J Chin Med Assoc 2019; 82:616-622. [PMID: 31135575 DOI: 10.1097/jcma.0000000000000124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A novel risk model to predict long-term mortality in patients with acute coronary syndrome (ACS), derived from the EPICOR (long-term follow-up of antithrombotic management patterns in acute coronary syndrome patients) registry, has been released recently and its performance remains to be assessed. The objective is to evaluate the EPICOR score for 2-year mortality risk in ACS patients after percutaneous coronary intervention (PCI). METHODS From January to December in 2013, a total of 6087 consecutive patients presenting with ACS who were scheduled for PCI were enrolled. Use online simplified EPICOR calculator to assess the expected risk of death. RESULTS Sixty-eight patients (1.1%) died during 2-year follow-up. The areas under the receiver operating characteristics curve for mortality in the overall population, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation ACS were 0.712 (95% CI, 0.650-0.772; p < 0.001), 0.790 (95% CI, 0.676-0.903; p < 0.001), and 0.683 (95% CI, 0.615-0.751; p < 0.001), respectively. Moreover, it was noninferior to the updated Global Registry of Acute Coronary Events (GRACE) risk score. Patients were stratified into three categories: low-risk (n = 3382), medium-risk (n = 2547), and high-risk (n = 158). Kaplan-Meier curve demonstrated significant ongoing divergence in both mortality (0.6% vs 1.3% vs 9.5%; p < 0.001) and major adverse cardiovascular and cerebrovascular events (MACCEs) (11.8% vs 12.3% vs 19.6%; p = 0.014) among them. Multivariate Cox analysis revealed that medium- and high-risk groups predicted 2- and 12-fold hazards of death comparing to the lowest. Yet, it was not a significant predictor for MACCEs after adjusting confounding factors. CONCLUSION The simplified EPICOR score showed fair discriminatory power of 2-year mortality in patients with ACS and an improved performance in the STEMI subgroup. It could aid in risk stratification of ACS patients as an independent predictor.
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Affiliation(s)
- Yue Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Fang Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jue Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jin-Qing Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Ventura M, Belleudi V, Sciattella P, Di Domenicantonio R, Di Martino M, Agabiti N, Davoli M, Fusco D. High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. PLoS One 2019; 14:e0212398. [PMID: 30785928 PMCID: PMC6382131 DOI: 10.1371/journal.pone.0212398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 02/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background The relationship between guideline adherence and outcomes in patients with acute myocardial infarction (AMI) has been widely investigated considering the emergency, acute, post-acute phases separately, but the effectiveness of the whole care process is not known. Aim The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI. Methods We conducted a cohort study selecting all incident cases of AMI from health information systems during 2011–2014 in the Lazio region. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. For each subject the probability to reach the hospital and the conditional probabilities to survive to 30 days from admission and to 31–365 days post discharge were estimated through multivariate logistic models. The 1-year survival probability was calculated as the product of the three probabilities. Quality of care indicators were identified in terms of emergency timeliness (time between residence and the nearest hospital), hospital performance in treatment of acute phase (number/timeliness of PCI on STEMI) and drug therapy in post-acute phase (number of drugs among antiplatelet, β-blockers, ACE inhibitors/ARBs, statins). The 1-year survival Probability Ratio (PR) and its Bootstrap Confidence Intervals (BCI) between who were exposed to the highest level of quality of care (timeliness<10', hospitalization in high performance hospital, complete drug therapy) and who exposed to the worst (timeliness≥10', hospitalization in low performance hospital, suboptimal drug therapy) were calculated for a mean-severity patient and varying gender and age. PRs for patients with diabetes and COPD were also evaluated. Results We identified 38,517 incident cases of AMI. The out-of-hospital mortality was 27.6%. Among the people arrived in hospital, 42.9% had a hospitalization for STEMI with 11.1% of mortality in acute phase and 5.4% in post-acute phase. For a mean-severity patient the PR was 1.19 (BCI 1.14–1.24). The ratio did not change by gender, while it moved from 1.06 (BCI 1.05–1.08) for age<65 years to 1.62 (BCI 1.45–1.80) for age >85 years. For patients with diabetes and COPD a slight increase in PRs was also observed. Conclusions The 1-year survival probability post AMI depends strongly on the quality of the whole multicomponent continuum of care. Improving the performance in the different phases, taking into account the relationship among these, can lead to considerable saving of lives, in particular for the elderly and for subjects with chronic diseases.
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Affiliation(s)
- Martina Ventura
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Paolo Sciattella
- Department of Statistical Sciences, “Sapienza” University of Rome, Rome, Italy
| | | | - Mirko Di Martino
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
- * E-mail:
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
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19
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Kratzer L, Noakes P, Baumwol J, Wrobel JP. Under-utilisation of β-blockers in patients with acute coronary syndrome and comorbid chronic obstructive pulmonary disease. Intern Med J 2019; 48:931-936. [PMID: 29573074 DOI: 10.1111/imj.13795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND β-blockers are an established mainstay of therapy in acute coronary syndrome (ACS). Despite substantial evidence of their safety and efficacy in chronic obstructive pulmonary disease (COPD) patients, their use in this population remains limited internationally, likely due to fears of inducing bronchospasm. In Australia, little is known about the use of β-blockers in COPD patients hospitalised for ACS. AIM To determine if β-blockers are under-prescribed at discharge for patients with COPD hospitalised for ACS compared to patients without a diagnosis of COPD. METHODS Retrospective analysis of a tertiary metropolitan hospital computer database was undertaken to identify the first 250 patients hospitalised with ACS from 1 March 2015. RESULTS Of the 250 patients analysed, there were five in-hospital fatalities, leaving 245 patients for final analysis. Patients with ACS and COPD received fewer β-blockers at discharge than those with ACS alone (66.7% vs 86.2%, P < 0.05). After controlling for clinically meaningful confounding factors, a logistic regression analysis model determined that, for patients with ACS, the presence of COPD was the only significant predictor of receiving a β-blocker at discharge. CONCLUSION Despite strong evidence supporting the use of β-blockers in COPD patients with ACS, Australian patients with COPD remain under-treated for ACS. More work is needed to alter prescribing attitudes.
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Affiliation(s)
- Logan Kratzer
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Department of Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Paul Noakes
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jay Baumwol
- Advanced Heart Failure Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jeremy P Wrobel
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
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20
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Petta V, Perlikos F, Loukides S, Bakakos P, Chalkias A, Iacovidou N, Xanthos T, Tsekoura D, Hillas G. Therapeutic effects of the combination of inhaled beta2-agonists and beta-blockers in COPD patients with cardiovascular disease. Heart Fail Rev 2018; 22:753-763. [PMID: 28840400 DOI: 10.1007/s10741-017-9646-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide, with co-morbidities contributing to the overall severity and mortality of the disease. The incidence and prevalence of cardiovascular disease among COPD patients are high. Both disorders often co-exist, mainly due to smoking, but they also share common underlying risk factors, such as aging and low-grade systemic inflammation. The therapeutic approach is based on agents, whose pharmacological properties are completely opposed. Beta2-agonists remain the cornerstone of COPD treatment due to their limited cardiac adverse effects. On the other hand, beta-blockers are administered in COPD patients with cardiovascular disease, but despite their proven cardiac benefits, they remain underused. There is still a trend among physicians over underprescription of these drugs in patients with heart failure and COPD due to bronchoconstriction. Therefore, cardioselective beta-blockers are preferred, and recent meta-analyses have shown reduced rates in mortality and exacerbations in COPD patients treated with beta-blockers.
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Affiliation(s)
- Vasiliki Petta
- Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Athens, Greece.
| | - Fotis Perlikos
- Pulmonary Division, Department of Critical Care, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Department of Respiratory Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, Athens, Greece
| | - Petros Bakakos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria University Hospital, Athens, Greece
| | - Athanasios Chalkias
- Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School, Aretaieio University Hospital, Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
- European University Cyprus, School of Medicine, Nicosia, Cyprus
| | - Dorothea Tsekoura
- Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Aretaieio University Hospital, Athens, Greece
| | - Georgios Hillas
- Pulmonary Division, Department of Critical Care, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
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21
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Foraker RE, Guha A, Chang H, O'Brien EC, Bower JK, Crouser ED, Rosamond WD, Raman SV. Survival After MI in a Community Cohort Study: Contribution of Comorbidities in NSTEMI. Glob Heart 2018; 13:13-18. [PMID: 29409724 PMCID: PMC5963709 DOI: 10.1016/j.gheart.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/24/2017] [Accepted: 01/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) comprises the majority of MI worldwide, yet mortality remains high. Management of NSTEMI is relatively delayed and heterogeneous compared with the "time is muscle" approach to ST-segment elevation MI, though it is unknown to what extent comorbid conditions drive NSTEMI mortality. OBJECTIVES We sought to quantify mortality due to MI versus comorbid conditions in patients with NSTEMI. METHODS Participants of the ARIC (Atherosclerosis Risk in Communities) study cohort ages 45 to 64 years, who developed incident NSTEMI were identified and incidence-density matched to participants who did not experience an MI by age group, sex, race, and study community. We estimated hazard ratios for all-cause mortality, comparing those who developed NSTEMI to those who did not experience an MI. RESULTS ARIC participants with incident NSTEMI were more likely at baseline to be smokers, have diabetes and renal dysfunction, and take blood pressure or cholesterol-lowering medications than were participants who did not have an MI. Over one-half of participants experiencing NSTEMI died over a median follow-up of 8.4 years; incident NSTEMI was associated with 30% higher risk of mortality after adjusting for comorbid conditions (hazard ratio: 1.30; 95% confidence interval: 1.11 to 1.53). CONCLUSIONS NSTEMI confers a significantly higher mortality hazard beyond what can be attributed to comorbid conditions. More consistent and effective strategies are needed to reduce mortality in NSTEMI amid comorbid conditions.
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Affiliation(s)
- Randi E Foraker
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA; Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | - Avirup Guha
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA
| | - Henry Chang
- Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | | | - Julie K Bower
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Elliott D Crouser
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University, Columbus, OH, USA
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Subha V Raman
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA.
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22
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Pinto P, Rothnie KJ, Lui K, Timmis A, Smeeth L, Quint JK. Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data. Chron Respir Dis 2018; 15:60-70. [PMID: 28393591 PMCID: PMC5802653 DOI: 10.1177/1479972317702140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/10/2017] [Accepted: 02/23/2017] [Indexed: 01/07/2023] Open
Abstract
Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with asthma compared to the general population have not been studied. A total of 300,161 people were identified with a first MI over the period 2003-2013 in the Myocardial Ischaemia National Audit Project database, of whom 8922 (3%) had asthma. Logistic regression was used to compare presentation, in-hospital care, in-hospital and 180-day post-discharge all-cause mortality in people with and without asthma adjusting for demographics and comorbidities, diagnosis on arrival and secondary prevention. People with asthma were more likely to have a delay in their MI diagnosis following an STEMI (ST-elevation myocardial infarction; odds ratio (OR) 1.38, confidence interval CI 1.06-1.79) but not an nSTEMI (non-ST-elevation myocardial infarction; OR 1.04, CI 0.92-1.17) compared to people without asthma and a delay in reperfusion (OR 1.19, CI 1.09-1.30) following an STEMI. They were much less likely to be discharged on a beta blocker following an STEMI or nSTEMI (OR 0.24, CI 0.21-0.28 and OR 0.27, CI 0.24-0.30, respectively). There was no difference in in-hospital or 180-day mortality (OR 0.98, CI 0.59-1.62 and OR 0.99, CI 0.72-1.36) following an STEMI or nSTEMI (OR 0.89, CI 0.47-1.68 and OR 1.05, CI 0.85-1.28). Although people with asthma were more likely to have a delay in diagnosis following an STEMI but not an nSTEMI compared to the general population, were more likely to have a delay in reperfusion therapy and were much less likely to receive beta blockers following an STEMI or nSTEMI, there was no difference in the prescriptions of other secondary prevention medications. None of the differences in presentation or management were associated with an increase in all-cause in-hospital or 180-day mortality in people with asthma compared to the general population.
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Affiliation(s)
- Paulo Pinto
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kieran J Rothnie
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kelvin Lui
- Faculty of Life Sciences, University College London, London, UK
| | - Adam Timmis
- Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer K Quint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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23
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Outcomes of Noninvasive and Invasive Ventilation in Patients Hospitalized with Asthma Exacerbation. Ann Am Thorac Soc 2018; 13:1096-104. [PMID: 27070493 DOI: 10.1513/annalsats.201510-701oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Little is known about the effectiveness of noninvasive ventilation for patients hospitalized with asthma exacerbation. OBJECTIVES To assess clinical outcomes of noninvasive (NIV) and invasive mechanical ventilation (IMV) and examine predictors for NIV use in patients hospitalized with asthma. METHODS This was a retrospective cohort study at 97 U.S. hospitals using an electronic medical record database. We developed a hierarchical regression model to identify factors associated with the choice of initial ventilation and used the Laboratory Acute Physiological Score to adjust for differences in the severity of illness. We assessed the outcomes of patients treated with initial NIV or IMV in a propensity-matched cohort. MEASUREMENTS AND MAIN RESULTS Among 13,930 subjects, 73% were women and 54% were white. The median age was 53 years. Overall, 1,254 patients (9%) required ventilatory support (NIV or IMV). NIV was the initial ventilation method for 556 patients (4.0%) and IMV for 668 (5.0%). Twenty-six patients (4.7% of patients treated with NIV) had to be intubated (NIV failure). The in-hospital mortality was 0.2, 2.3, 14.5, and 15.4%, and the median length of stay was 2.9, 4.1, 6.7, and 10.9 days among those not ventilated, ventilated with NIV, ventilated with IMV, and with NIV failure, respectively. Older patients were more likely to receive NIV (odds ratio, 1.06 per 5 yr; 95% confidence interval [CI], 1.01-1.11), whereas those with higher acuity (Laboratory Acute Physiological Score per 5 units: odds ratio, 0.85; 95% CI, 0.82-0.88) and those with concomitant pneumonia were less likely to receive NIV. In a propensity-matched sample, NIV was associated with a lower inpatient risk of dying (risk ratio, 0.12; 95% CI, 0.03-0.51) and shorter lengths of stay (4.3 d less; 95% CI, 2.9-5.8) than IMV. CONCLUSIONS Among patients hospitalized with asthma exacerbation and requiring ventilatory support (NIV or IMV), more than 40% received NIV. Although patients successfully treated with NIV appear to have better outcomes than those treated with IMV, the low rate of NIV failure suggests that NIV was being used selectively in a lower risk group. The increased risk of mortality for patients who fail NIV highlights the need for careful monitoring to avoid possible delay in intubation.
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24
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Labaki WW, Martinez CH, Martinez FJ, Galbán CJ, Ross BD, Washko GR, Barr RG, Regan EA, Coxson HO, Hoffman EA, Newell JD, Curran-Everett D, Hogg JC, Crapo JD, Lynch DA, Kazerooni EA, Han MK. The Role of Chest Computed Tomography in the Evaluation and Management of the Patient with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 196:1372-1379. [PMID: 28661698 DOI: 10.1164/rccm.201703-0451pp] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | - Fernando J Martinez
- 2 New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | | | | | - George R Washko
- 3 Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Graham Barr
- 4 New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | | | - Harvey O Coxson
- 6 University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | | | | | - James C Hogg
- 6 University of British Columbia, Vancouver, British Columbia, Canada; and
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25
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Andell P, Sjögren J, Batra G, Szummer K, Koul S. Outcome of patients with chronic obstructive pulmonary disease and severe coronary artery disease who had a coronary artery bypass graft or a percutaneous coronary intervention. Eur J Cardiothorac Surg 2017; 52:930-936. [DOI: 10.1093/ejcts/ezx219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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26
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Goedemans L, Abou R, Hoogslag GE, Ajmone Marsan N, Taube C, Delgado V, Bax JJ. Comparison of Left Ventricular Function and Myocardial Infarct Size Determined by 2-Dimensional Speckle Tracking Echocardiography in Patients With and Without Chronic Obstructive Pulmonary Disease After ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017; 120:734-739. [PMID: 28689753 DOI: 10.1016/j.amjcard.2017.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/16/2017] [Accepted: 06/05/2017] [Indexed: 11/26/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have a high risk of mortality after acute ST-segment elevation myocardial infarction (STEMI). We compared STEMI patients with versus without COPD in terms of infarct size and left ventricular (LV) systolic function using advanced 2-dimensional speckle tracking echocardiography. Of 1,750 patients with STEMI (mean age 61 ± 12 years, 76% male), 133 (7.6%) had COPD. With transthoracic echocardiography, left ventricular ejection fraction (LVEF) and wall motion score index were measured. Infarct size was assessed using biomarkers (creatine kinase and troponin T). LV global longitudinal strain (GLS), reflecting active LV myocardial deformation, was measured with 2-dimensional speckle tracking echocardiography to estimate LV systolic function and infarct size. STEMI patients with COPD were significantly older, more likely to be former smokers, and had worse renal function compared with patients without COPD. There were no differences in infarct size based on peak levels of creatine kinase (1315 [613 to 2181] vs 1477 [682 to 3047] U/l, p = 0.106) and troponin T (3.3 [1.4 to 7.3] vs 3.9 [1.5 to 7.8] µg/l, p = 0.489). Left ventricular ejection fraction (46% vs 47%, p = 0.591) and wall motion score index (1.38 [1.25 to 1.66] vs 1.38 [1.19 to 1.69], p = 0.690) were comparable. In contrast, LV GLS was significantly more impaired in patients with COPD compared with patients without COPD (-13.9 ± 3.0% vs -14.7 ± 3.9%, p = 0.034). In conclusion, despite comparable myocardial infarct size and LV systolic function as assessed with biomarkers and conventional echocardiography, patients with COPD exhibit more impaired LV GLS on advanced echocardiography than patients without COPD, suggesting a greater functional impairment at an early stage after STEMI.
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27
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Neef PA, McDonald CF, Burrell LM, Irving LB, Johnson DF, Steinfort DP. Beta-blockers are under-prescribed in patients with chronic obstructive pulmonary disease and co-morbid cardiac disease. Intern Med J 2017; 46:1336-1340. [PMID: 27813357 DOI: 10.1111/imj.13240] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/30/2016] [Accepted: 06/21/2016] [Indexed: 11/29/2022]
Abstract
The use of beta-blockers in patients with chronic obstructive pulmonary disease and co-morbid cardiovascular disease is controversial, despite increasing evidence to support their use as safe and efficacious. This study retrospectively assessed the rates of beta-blocker prescription in patients admitted to two Australian tertiary hospitals for acute exacerbation of chronic obstructive pulmonary disease. This revealed that less than half of patients (45%) with known cardiac indications were receiving beta-blocker therapy, evident across all degrees of airways disease severity. Further work is needed to ensure that medical management of this patient group is optimised.
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Affiliation(s)
- P A Neef
- General Medicine, Melbourne, Victoria, Australia.
| | - C F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - L M Burrell
- Department of Medicine and Cardiology, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - L B Irving
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Melbourne Health, Melbourne, Victoria, Australia
| | - D F Johnson
- General Medicine, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - D P Steinfort
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Melbourne Health, Melbourne, Victoria, Australia
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28
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Corrao S, Brunori G, Lupo U, Perticone F. Effectiveness and safety of concurrent beta-blockers and inhaled bronchodilators in COPD with cardiovascular comorbidities. Eur Respir Rev 2017; 26:26/145/160123. [DOI: 10.1183/16000617.0123-2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease and its prevalence is increasing worldwide, in both industrialised and developing countries. Its prevalence is ∼5% in the general population and it is the fourth leading cause of death worldwide. COPD is strongly associated with cardiovascular diseases; in fact, ∼64% of people suffering from COPD are treated for a concomitant cardiovascular disease and approximately one in three COPD patients die as a consequence of cardiovascular diseases.Inhaled bronchodilators might have adverse cardiovascular effects, including ischaemic events and arrhythmias, and beta-blockers might adversely influence the respiratory symptoms and the response to bronchodilators. For these reasons, it is important to know the safety profiles and the possible interactions between these two classes of drug, in order to prescribe them with greater awareness.In this article, we review the literature about the epidemiology of COPD, its association with cardiovascular diseases, and the safety of concurrent use of inhaled bronchodilators and beta-blockers, as a tool for improving the approach to complex therapies in clinical practice.
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Agarwal M, Agrawal S, Garg L, Garg A, Bhatia N, Kadaria D, Reed G. Effect of Chronic Obstructive Pulmonary Disease on In-Hospital Mortality and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017; 119:1555-1559. [PMID: 28390680 DOI: 10.1016/j.amjcard.2017.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
There is controversy regarding in-hospital mortality, revascularization, and other adverse outcomes in patients with ST-segment elevation (STEMI) and chronic obstructive pulmonary disease (COPD). We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients aged ≥18 years with a primary diagnosis of STEMI. Univariate and multivariate analyses were performed to evaluate the association of COPD with in-hospital clinical outcomes. Patients with COPD comprised 13.2% of 2,120,005 patients with STEMI. COPD was associated with older age, Medicare insurance, greater co-morbidities, and lower socioeconomic status. Compared with non-COPD patients, patients with COPD had higher inpatient mortality even after adjustment for multiple potential other factors (12.5% vs 8.6%, adjusted odds ratio [AOR] 1.13, 95% CI 1.11 to 1.15, p <0.001). Patients with COPD were more likely to develop new-onset heart failure (AOR 2.01, 95% CI 1.99 to 2.03), cardiogenic shock (AOR 1.24, 95% CI 1.22 to 1.26), and acute respiratory failure (AOR 2.46, 95% CI 2.43 to 2.50) during their hospital stay. Patients with COPD were less likely to undergo diagnostic angiographies and any revascularization procedures. The mean length of stay (6.0 vs 4.6 days; p <0.001) was greater in patients with COPD, as were hospital average hospital charges ($63,956 vs $58,536; p <0.001). In conclusion, among patients with STEMI, COPD is associated with a greater risk of in-hospital mortality, new-onset heart failure, acute respiratory failure, and cardiogenic shock.
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30
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Șerban RC, Hadadi L, Șuș I, Lakatos EK, Demjen Z, Scridon A. Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2017; 243:437-442. [PMID: 28506549 DOI: 10.1016/j.ijcard.2017.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to beneficiate of primary percutaneous coronary intervention (pPCI), and have poorer prognosis. We aimed to evaluate the impact of COPD on the in-hospital outcomes of pPCI-treated STEMI patients. METHODS Data were collected from 418 STEMI patients treated by pPCI. Inotropics and diuretics usage, cardiogenic shock, asystole, kidney dysfunction, and left ventricular ejection fraction were used as markers of hemodynamic complications. Atrial and ventricular fibrillation, conduction disorders, and antiarrhythmics usage were used as markers of arrhythmic complications. In-hospital mortality was evaluated. The associations between these parameters and COPD were assessed. RESULTS COPD was present in 7.42% of STEMI patients. COPD patients were older (p=0.02) and less likely to receive beta-blockers (OR 0.29; 95%CI 0.13-0.64; p<0.01). They had higher Killip class on admission (p<0.001), received more often inotropics (p<0.001) and diuretics (p<0.01), and presented more often atrial (p=0.01) and ventricular fibrillation (p=0.02). Unadjusted in-hospital mortality was higher in COPD patients (OR 4.18, 95%CI 1.55-11.30, p<0.01). After adjustment for potentially confounding factors except beta-blockers, COPD remained an independent predictor of in-hospital mortality (p=0.02). After further adjustment with beta-blocker therapy, no excess mortality was noted in COPD patients. CONCLUSIONS Despite being treated by pPCI, COPD patients with STEMI are more likely to develop hemodynamic and arrhythmic complications, and have higher in-hospital mortality. This appears to be due to lower beta-blockers usage in COPD patients. Increasing beta-blockers usage in COPD patients with STEMI may improve survival.
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Affiliation(s)
- Răzvan Constantin Șerban
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Laszlo Hadadi
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Ioana Șuș
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Eva Katalin Lakatos
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Zoltan Demjen
- Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania
| | - Alina Scridon
- University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania.
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Dong YH, Alcusky M, Maio V, Liu J, Liu M, Wu LC, Chang CH, Lai MS, Gagne JJ. Evidence of potential bias in a comparison of β blockers and calcium channel blockers in patients with chronic obstructive pulmonary disease and acute coronary syndrome: results of a multinational study. BMJ Open 2017; 7:e012997. [PMID: 28363921 PMCID: PMC5387948 DOI: 10.1136/bmjopen-2016-012997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES A number of observational studies have reported that, in patients with chronic obstructive pulmonary disease (COPD), β blockers (BBs) decrease risk of mortality and COPD exacerbations. To address important methodological concerns of these studies, we compared the effectiveness and safety of cardioselective BBs versus non-dihydropyridine calcium channel blockers (non-DHP CCBs) in patients with COPD and acute coronary syndromes (ACS) using a propensity score (PS)-matched, active comparator, new user design. We also assessed for potential unmeasured confounding by examining a short-term COPD hospitalisation outcome. SETTING AND PARTICIPANTS We identified 22 985 patients with COPD and ACS starting cardioselective BBs or non-DHP CCBs across 5 claims databases from the USA, Italy and Taiwan. PRIMARY AND SECONDARY OUTCOME MEASURES Stratified Cox regression models were used to estimate HRs for mortality, cardiovascular (CV) hospitalisations and COPD hospitalisations in each database after variable-ratio PS matching. Results were combined with random-effects meta-analyses. RESULTS Cardioselective BBs were not associated with reduced risk of mortality (HR, 0.90; 95% CI 0.78 to 1.02) or CV hospitalisations (HR, 1.06; 95% CI 0.91 to 1.23), although statistical heterogeneity was observed across databases. In contrast, a consistent, inverse association for COPD hospitalisations was identified across databases (HR, 0.54; 95% CI 0.47 to 0.61), which persisted even within the first 30 days of follow-up (HR, 0.55; 95% CI 0.37 to 0.82). Results were similar across a variety of sensitivity analyses, including PS trimming, high dimensional-PS matching and restricting to high-risk patients. CONCLUSIONS This multinational study found a large inverse association between cardioselective BBs and short-term COPD hospitalisations. The persistence of this bias despite state-of-the-art pharmacoepidemiologic methods calls into question the ability of claims data to address confounding in studies of BBs in patients with COPD.
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Affiliation(s)
- Yaa-Hui Dong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Pharmacy, National Yang-Ming University, Taipei, Taiwan
| | - Matthew Alcusky
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Vittorio Maio
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mengdan Liu
- Center for Research in Medical Education and Health Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Li-Chiu Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Ooi H, Chen LH, Ni YL, Shen HT, Lee YH, Chu YC, Fang KC, Chen IH, Hsu SL, Chen HC, Huang CH, Fan KS, Lai CL, Hang LW. CHA2DS2-VASc scores predict major adverse cardiovascular events in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2017; 12:1038-1045. [PMID: 28268258 DOI: 10.1111/crj.12624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/29/2016] [Accepted: 02/26/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) frequently experience concurrent comorbidities; therefore, risk assessment for major adverse cardiovascular events (MACEs) is very important. OBJECTIVES We explored the association between COPD and risk of MACEs with three common clinical events: acute myocardial infarction (AMI), ischemic stroke (IS), and cardiovascular death (CVD). METHODS We evaluated the predictive value of the CHA2DS2-VASc score (congestive heart failure [C], hypertension [H], age [A], diabetes [D], stroke [S], and vascular disease [VASc]) for MACEs in COPD patients. In this observational study, we retrospectively reviewed the records of 29 258 patients with COPD between 2005 and 2009 in relation to MACE risk using the CHA2DS2-VASc score. We calculated the hazard ratios (HR) and 95% confidence intervals (CI) using a significance level of .05. RESULTS Patients with COPD had significantly (P < .001) increased risk of MACEs, and a high prevalence of CHA2DS2-VASc scores ≥ 6, predicting MACEs (16.1%), AMI (3.3%), IS (8.7%), and CVD (4.0%). A good discrimination was found for MACEs, IS events, and CVD events (AUC = 0.740, 0.739, and 0.778, respectively) but poorer discrimination for AMI events (AUC = 0.697). CONCLUSION Early lifestyle modifications and antithrombotic therapy may be essential for COPD patients at a high risk of MACEs, that is, those with CHA2DS2-VASc scores ≥ 6.
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Affiliation(s)
- Hean Ooi
- Department of Preventive Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan.,Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan.,Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, No. 11, Buzih Lane 40601, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taiwan. No. 2, Yu der Road, Taichung City 40447, Taiwan
| | - Li-Hsiou Chen
- Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan
| | - Yung-Lun Ni
- Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan
| | - Huan-Ting Shen
- Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan
| | - Yen-Hsien Lee
- Division Chest, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taiwan. No. 66, Sec. 1, Fongsing Road, Tanzi District, Taichung City 427, Taiwan
| | - Yi-Chun Chu
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - Ke-Chih Fang
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - I-Hung Chen
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - Shu-Lan Hsu
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - Hsing-Chun Chen
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - Chien-Hsiu Huang
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - Kuo-Sheng Fan
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - Chun-Liang Lai
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Taiwan. No.2, Minsheng Rd, Dalin Township Chiayi County 622, Taiwan
| | - Liang-Wen Hang
- Department of Internal Medicine, Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan.,Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, Asia University, Taichung, Taiwan
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Su TH, Chang SH, Chen PC, Chan YL. Temporal Trends in Treatment and Outcomes of Acute Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Observational Study. J Am Heart Assoc 2017; 6:e004525. [PMID: 28298371 PMCID: PMC5524002 DOI: 10.1161/jaha.116.004525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute myocardial infarction is a major cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD); however, temporal trends in the management and clinical outcomes of these patients remain unclear. METHODS AND RESULTS We conducted an observational study by using a representative sample of 1 million beneficiaries from the Taiwan National Health Insurance Research Database. Comorbidities, in-hospital treatment, and outcomes were compared for patients with acute myocardial infarction with and without COPD between 2004 and 2013. Temporal trends in treatment and outcomes were analyzed. We included 6770 patients admitted to hospitals with acute myocardial infarction diagnoses, of whom 1921 (28.3%) had COPD. Fewer patients with COPD received β-blockers (adjusted odds ratio 0.66, 95% CI 0.59-0.74), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (adjusted odds ratio 0.83, 95% CI 0.73-0.93), statins, anticoagulants, dual antiplatelets, and coronary interventions. These patients had higher mortality (in hospital: adjusted hazard ratio 1.25 [95% CI 1.11-1.41]; 1 year: adjusted hazard ratio 1.20 [95% CI 1.09-1.32]) and respiratory failure risk during admission. Temporal trends showed little improvement in mortality in patients with COPD over 10 years. Multivariable logistic regression indicated that dual antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, coronary angiography, and coronary artery bypass grafting surgery were significantly correlated with improved mortality in patients with COPD. CONCLUSIONS In Taiwan, a lower proportion of patients with COPD received evidence-based therapies for acute myocardial infarction than did patients without COPD, and their clinical outcomes were inferior. Limited improvement in mortality was observed over the preceding 10 years and is attributable to the underuse of evidence-based treatments.
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Affiliation(s)
- Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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Timóteo AT. Is there still a place for improvement in acute coronary syndrome risk stratification?: Table 1. BRITISH HEART JOURNAL 2016; 102:1423-4. [DOI: 10.1136/heartjnl-2016-309860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Franssen FME, Soriano JB, Roche N, Bloomfield PH, Brusselle G, Fabbri LM, García-Rio F, Kearney MT, Kwon N, Lundbäck B, Rabe KF, Raillard A, Muellerova H, Cockcroft JR. Lung Function Abnormalities in Smokers with Ischemic Heart Disease. Am J Respir Crit Care Med 2016; 194:568-76. [DOI: 10.1164/rccm.201512-2480oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Rothnie KJ, Smeeth L, Pearce N, Herrett E, Timmis A, Hemingway H, Wedzicha J, Quint JK. Predicting mortality after acute coronary syndromes in people with chronic obstructive pulmonary disease. Heart 2016; 102:1442-8. [PMID: 27177534 PMCID: PMC5013109 DOI: 10.1136/heartjnl-2016-309359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/21/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the accuracy of Global Registry of Acute Coronary Events (GRACE) scores in predicting mortality at 6 months for people with chronic obstructive pulmonary disease (COPD) and to investigate how it might be improved. Methods Data were obtained on 481 849 patients with acute coronary syndrome admitted to UK hospitals between January 2003 and June 2013 from the Myocardial Ischaemia National Audit Project (MINAP) database. We compared risk of death between patients with COPD and those without COPD at 6 months, adjusting for predicted risk of death. We then assessed whether several modifications improved the accuracy of the GRACE score for people with COPD. Results The risk of death after adjusting for GRACE score predicted that risk of death was higher for patients with COPD than that for other patients (RR 1.29, 95% CI 1.28 to 1.33). Adding smoking into the GRACE score model did not improve accuracy for patients with COPD. Either adding COPD into the model (relative risk (RR) 1.00, 0.94 to 1.02) or multiplying the GRACE score by 1.3 resulted in better performance (RR 0.99, 0.96 to 1.01). Conclusions GRACE scores underestimate risk of death for people with COPD. A more accurate prediction of risk of death can be obtained by adding COPD into the GRACE score equation, or by multiplying the GRACE score predicted risk of death by 1.3 for people with COPD. This means that one third of patients with COPD currently classified as low risk should be classified as moderate risk, and could be considered for more aggressive early treatment after non-ST-segment elevation myocardial infarction or unstable angina.
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Affiliation(s)
- Kieran J Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Farr Institute of Health Informatics Research, London, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Herrett
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam Timmis
- Farr Institute of Health Informatics Research, London, UK Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, London, UK Department of Epidemiology and Public Health, University College London, London, UK
| | - Jadwiga Wedzicha
- Airway Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Rothnie KJ, Quint JK. Chronic obstructive pulmonary disease and acute myocardial infarction: effects on presentation, management, and outcomes. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:81-90. [PMID: 29474627 PMCID: PMC5862020 DOI: 10.1093/ehjqcco/qcw005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD) and is a key target for improving outcomes. However, there are concerns that patients with COPD may not have enjoyed the same mortality reductions from acute myocardial infarction (AMI) in recent decades as the general population. This has raised questions about differences in presentation, management and outcomes in COPD patients compared to non-COPD patients. The evidence points to an increased risk of death after AMI in patients with COPD, but it is unclear to what extent this is attributable to COPD itself or to modifiable factors including under-treatment with guideline-recommended interventions and drugs. We review the evidence for differences between COPD and non-COPD patients in terms of the presentation of AMI, its treatment, and outcomes both in hospital and in the longer term.
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Affiliation(s)
- Kieran J. Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K. Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, London SW3 6LR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Campo G, Pavasini R, Malagù M, Mascetti S, Biscaglia S, Ceconi C, Papi A, Contoli M. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther 2016; 29:147-57. [PMID: 25645653 DOI: 10.1007/s10557-014-6569-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In the last few years, many studies focused their attention on the relationship between chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD), showing that these diseases are mutually influenced. Many different biological processes such as hypoxia, systemic inflammation, endothelial dysfunction, heightened platelet reactivity, arterial stiffness and right ventricle modification interact in the development of the COPD-IHD comorbidity, which therefore deserves special attention in early diagnosis and treatment. Patients with COPD-IHD comorbidity have a worst outcome, when compared to patients with only COPD or only IHD. These patients showed a significant increase on risk of adverse events and of hospital readmissions for recurrent myocardial infarction, heart failure, coronary revascularization, and acute exacerbation of COPD. Taken together, these complications determine a significant increase in mortality. In most cases death occurs for cardiovascular cause, soon after an acute exacerbation of COPD or a cardiovascular adverse event. Recent data regarding incidence, mechanisms and prognosis of this comorbidity, along with the development of new drugs and interventional approaches may improve the management and long-term outcome of COPD-IHD patients. The aim of this review is to describe the current knowledge on COPD-IHD comorbidity. Particularly, we focused our attention on underlying pathological mechanisms and on all treatment and strategies that may improve and optimize the clinical management of COPD-IHD patients.
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Affiliation(s)
- Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna di Ferrara, Cona, FE, Italy,
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Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease. THE LANCET RESPIRATORY MEDICINE 2016; 4:138-48. [DOI: 10.1016/s2213-2600(15)00509-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022]
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Polikutina OM, Slepynina YS, Bazdyrev ED, Karetnikova VN, Barbarach OL. [Impact of chronic obstructive pulmonary disease on one-year prognosis in patients with ST-segment elevation myocardial infarction]. TERAPEVT ARKH 2015; 87:52-57. [PMID: 26591553 DOI: 10.17116/terarkh201587952-57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the role of chronic obstructive pulmonary disease (COPD) in the development of unfavorable outcomes of long-term (one-year) prognosis of ST-elevation myocardial infarction (STEMI). SUBJECTS AND METHODS A total of 529 patients diagnosed with STEMI and no age limits were examined. Group 1 included 65 (12.3%) patients with previously diagnosed COPD; Group 2 consisted of 464 (87.7%) patients without COPD. One-year prognosis was studied in 384 (81.5%) patients. The investigators evaluated the following endpoints: evolving recurrent myocardial infarction (MI), progressive angina pectoris, decompensated chronic heart failure (CHF), repeat percutaneous coronary interventions, stroke, and death. RESULTS The prevalence of COPD was 12.3% in the patients with STEM]. Unfavorable one-year prognosis was significantly more often registered in the comorbidity group regardless of age, gender, and smoking status. COPD increased the risk of combined endpoints by 1.9 times within a year after MI and that of decompensated CHD by 2.6 times during a year after STEM. CONCLUSION COPD may be an independent risk factor for unfavorable outcomes during a year after MI.
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Affiliation(s)
- O M Polikutina
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Yu S Slepynina
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - E D Bazdyrev
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - V N Karetnikova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - O L Barbarach
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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42
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Puente-Maestu L, Álvarez-Sala LA, de Miguel-Díez J. Beta-blockers in patients with chronic obstructive disease and coexistent cardiac illnesses. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40749-015-0013-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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43
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Rothnie KJ, Yan R, Smeeth L, Quint JK. Risk of myocardial infarction (MI) and death following MI in people with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMJ Open 2015; 5:e007824. [PMID: 26362660 PMCID: PMC4567661 DOI: 10.1136/bmjopen-2015-007824] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible. RESULTS Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40). CONCLUSIONS There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI.
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Affiliation(s)
- Kieran J Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruoling Yan
- Medical School, Faculty of Medical Sciences, University College London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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44
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Di Daniele N. Therapeutic approaches of uncomplicated arterial hypertension in patients with COPD. Pulm Pharmacol Ther 2015; 35:1-7. [PMID: 26363278 DOI: 10.1016/j.pupt.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/03/2015] [Accepted: 09/06/2015] [Indexed: 12/23/2022]
Abstract
The concomitant presence of systemic arterial hypertension and chronic obstructive pulmonary disease (COPD) is frequent. Indeed, arterial hypertension is the most common comorbid disease in COPD patients. Since many antihypertensive drugs can act on airway function the treatment of arterial hypertension in COPD patients appears complex. Moreover, in these patients, a combined therapy is required for the adequate control of blood pressure. Currently, available data are inconsistent and not always comparable. Therefore the aim of this review is to analyze how antihypertensive drugs can affect airway function in order to improve the clinical management of hypertensive patients with COPD. Thiazide diuretics and calcium channel blockers appear the first-choice pharmacological treatment for these patients.
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Affiliation(s)
- Nicola Di Daniele
- Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", via Montpellier 1, 00133, Rome, Italy.
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45
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Rajagopalan S, Brook RD. Mortality from myocardial infarction in chronic obstructive pulmonary disease: minding and mending the 'Gap'. Heart 2015; 101:1085-6. [PMID: 25903838 DOI: 10.1136/heartjnl-2015-307739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sanjay Rajagopalan
- Division of Cardiovascular Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Robert D Brook
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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46
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Tisminetzky M, McManus DD, Dor A, Miozzo R, Yarzebski J, Gore JM, Goldberg RJ. Decade-long trends (1999-2009) in the characteristics, management, and hospital outcomes of patients hospitalized with acute myocardial infarction with prior diabetes and chronic kidney disease. Int J Nephrol Renovasc Dis 2015; 8:41-51. [PMID: 25999755 PMCID: PMC4427079 DOI: 10.2147/ijnrd.s78749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999–2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities. Methods We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all eleven medical centers in central Massachusetts. Our sample consisted of the following four groups: DM with CKD (n=587), CKD without DM (n=524), DM without CKD (n=1,442), and non-DM/non-CKD (n=3,465). Results Diabetic patients with CKD were more likely to have a higher prevalence of previously diagnosed comorbidities, to have developed heart failure acutely, and to have a longer hospital stay compared with non-DM/non-CKD patients. Between 1999 and 2009, there were marked increases in the prescribing of beta-blockers, statins, and aspirin for patients with CKD and DM as compared to those without these comorbidities. In-hospital death rates remained unchanged in patients with DM and CKD, while they declined markedly in patients with CKD without DM (20.2% dying in 1999; 11.3% dying in 2009). Conclusion Despite increases in the prescribing of effective cardiac medications, AMI patients with DM and CKD continue to experience high in-hospital death rates.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Alon Dor
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Ruben Miozzo
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA ; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Joel M Gore
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
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47
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Andell P, Erlinge D, Smith JG, Sundström J, Lindahl B, James S, Koul S. β-blocker use and mortality in COPD patients after myocardial infarction: a Swedish nationwide observational study. J Am Heart Assoc 2015; 4:e001611. [PMID: 25854796 PMCID: PMC4579937 DOI: 10.1161/jaha.114.001611] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with myocardial infarction (MI) and concomitant chronic obstructive pulmonary disease (COPD) constitute a high-risk group with increased mortality. β-Blocker therapy has been shown to reduce mortality, prevent arrhythmias, and delay heart failure development after an MI in broad populations. However, the effect of β-blockers in COPD patients is less well established and they may also be less treated due to fear of adverse reactions. We investigated β-blocker prescription at discharge in patients with COPD after MI. METHODS AND RESULTS Patients hospitalized for MI between 2005 and 2010 were identified from the nationwide Swedish SWEDEHEART registry. Patients with COPD who were alive and discharged after an MI were selected as the study population. In this cohort, patients who were discharged with β-blockers were compared to patients not discharged with β-blockers. The primary end point was all-cause mortality. A total of 4858 patients were included, of which 4086 (84.1%) were discharged with a β-blocker while 772 (15.9%) were not. After adjusting for potential confounders including baseline characteristics, comorbidities, and in-hospital characteristics, patients discharged with a β-blocker had lower all-cause mortality (hazard ratio 0.87, 95% CI 0.78 to 0.98) during the total follow-up time (maximum 7.2 years). In the subgroup of patients with a history of heart failure, the corresponding hazard ratio was 0.77 (95% CI 0.63 to 0.95). CONCLUSIONS Patients with COPD discharged with β-blockers after an MI had a lower all-cause mortality compared to patients not prescribed β-blockers. The results indicate that MI patients with COPD may benefit from β-blockers.
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Affiliation(s)
- Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
| | - J. Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
| | - Johan Sundström
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (J.S., B.L., S.J.)
| | - Bertil Lindahl
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (J.S., B.L., S.J.)
| | - Stefan James
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (J.S., B.L., S.J.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden (P.A., D.E., G.S., S.K.)
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48
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Rothnie KJ, Smeeth L, Herrett E, Pearce N, Hemingway H, Wedzicha J, Timmis A, Quint JK. Closing the mortality gap after a myocardial infarction in people with and without chronic obstructive pulmonary disease. Heart 2015; 101:1103-10. [PMID: 25765553 PMCID: PMC4516011 DOI: 10.1136/heartjnl-2014-307251] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/13/2015] [Indexed: 11/06/2022] Open
Abstract
Objective Patients with chronic obstructive pulmonary disease (COPD) have increased mortality following myocardial infarction (MI) compared with patients without COPD. We investigated the extent to which differences in recognition and management after MI could explain the mortality difference. Methods 300 161 patients with a first MI between 2003 and 2013 were identified in the UK Myocardial Ischaemia National Audit Project database. Logistic regression was used to compare mortality in hospital and at 180 days postdischarge between patients with and without COPD. Variables relating to inhospital factors (delay in diagnosis, use of reperfusion and time to reperfusion/use of angiography) and use of secondary prevention were sequentially added to models. Results Mortality was higher for patients with COPD both inhospital (4.6% vs 3.2%) and at 180 days (12.8% vs 7.7%). After adjusting for inhospital factors, the effect of COPD on inhospital mortality after MI was reduced for both ST-elevation myocardial infarctions (STEMIs) and non-STEMIs (STEMIs OR 1.24 (95% CI 1.10 to 1.41) to 1.13 (95% CI 0.99 to 1.29); non-STEMIs OR 1.34 (95% CI 1.24 to 1.45) to 1.16 (95% CI 1.07 to 1.26)). Adjusting for inhospital factors reduced the effect of COPD on mortality after non-STEMI at 180 days (OR 1.56 (95% CI 1.47 to 1.65) to 1.37 (95% CI 1.31 to 1.44)). Adjusting for use of secondary prevention also reduced the effect of COPD on mortality at 180 days for STEMIs and non-STEMIs (STEMIs OR 1.45 (95% CI 1.31 to 1.61) to 1.25 (95% CI 1.11 to 1.41); non-STEMIs OR 1.37 (95% CI 1.31 to 1.44) to 1.26 (95% CI 1.17 to 1.35). Conclusions Delayed diagnosis, timing and use of reperfusion of a STEMI, use of angiography after a non-STEMI and use of secondary prevention medicines are all potential explanations for the mortality gap after MI in people with COPD.
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Affiliation(s)
- Kieran J Rothnie
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Farr Institute of Health Informatics Research, London, UK
| | - Emily Herrett
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, London, UK Department of Epidemiology and Public Health, University College London, London, UK
| | - Jadwiga Wedzicha
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam Timmis
- Farr Institute of Health Informatics Research, London, UK Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Jennifer K Quint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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49
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Malerba M, Montuschi P, Radaeli A, Pirisi M. Role of beta-blockers in patients with COPD: current perspective. Drug Discov Today 2015; 20:129-35. [DOI: 10.1016/j.drudis.2014.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/13/2014] [Accepted: 09/09/2014] [Indexed: 11/25/2022]
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50
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β-Blockers in COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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