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Li J, Su J, Tong Z, Liang L. Utilizing EMR Data for Smoking Behavior Surveillance in Hospitalized Patients With Chronic Respiratory Diseases and Its Impact on Clinical Outcomes - Beijing Municipality, China, 2014-2023. China CDC Wkly 2024; 6:530-534. [PMID: 38855572 PMCID: PMC11154101 DOI: 10.46234/ccdcw2024.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
What is already known on this topic? Smoking is the primary risk factor for a poor prognosis in chronic respiratory disease (CRD). Current tobacco surveillance efforts in China focus on the general population and do not adequately cover CRD patients. What is added by this report? We employed electronic medical records (EMR) to track smoking habits in 28,334 hospitalized CRD patients at Beijing Chao-Yang Hospital. The rates of former and current smokers were 30.7% and 18.0%, respectively. Both former and current smokers exhibited an increased risk of respiratory symptoms and extended hospital stays. What are the implications for public health practice? These results underscore the importance of implementing smoking monitoring and targeted cessation interventions for hospitalized patients with CRDs.
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Affiliation(s)
- Jiachen Li
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jian Su
- School of Economics, Peking University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lirong Liang
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Qalby N, Arsyad DS, Qanitha A, Cramer MJ, Appelman Y, Pabittei DR, Doevendans PA, Mappangara I, Muzakkir AF. In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia. BMC Health Serv Res 2024; 24:284. [PMID: 38443913 PMCID: PMC10916244 DOI: 10.1186/s12913-024-10637-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS). METHODS This is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis. RESULTS We observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001). CONCLUSIONS This study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.
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Affiliation(s)
- Nurul Qalby
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Public Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Dian S Arsyad
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Andriany Qanitha
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Cardiovascular Sciences, Amsterdam UMC Location VUMC, Amsterdam, the Netherlands
| | - Dara R Pabittei
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Cardiothoracic Surgery, AMC Heart Center, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Akhtar Fajar Muzakkir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
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Zhao G, Zhou M, Zhao X, Ma C, Han Y, Liu J, Zhao D, Nie S. Characteristics, Treatment, and In-Hospital Outcomes of Older Patients With STEMI Without Standard Modifiable Risk Factors. JACC. ASIA 2024; 4:73-83. [PMID: 38222256 PMCID: PMC10782397 DOI: 10.1016/j.jacasi.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 01/16/2024]
Abstract
Background Strategies targeting standard modifiable cardiovascular risk factors (SMuRFs), including hypertension, diabetes, hypercholesterolemia, and smoking, have been well established to prevent coronary heart disease. However, few studies have evaluated the management and outcomes of older patients without SMuRFs after myocardial infarction. Objectives The authors sought to evaluate the profile of patients with ST-segment elevation myocardial infarction (STEMI) aged ≥75 years without SMuRFs. Methods This study is based on the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project. Patients aged ≥75 years with a first presentation of STEMI were enrolled in this study between November 2014 and December 2019. Modified Poisson regression was used to evaluate the association between SMuRF-less and in-hospital outcomes. Results Among 10,775 patients with STEMI aged ≥75 years, 1,633 (15.16%) had no SMuRFs. Compared with those with SMuRF, SMuRF-less patients received less evidence-based treatment. In-hospital mortality was similar among patients with and without SMuRFs (5.44% vs 5.14%; P = 0.630). However, after adjustment for patient characteristics and treatment, being SMuRF-less was significantly associated with a reduced risk of mortality (RR: 0.80; 95% CI: 0.65-0.99; P = 0.043). SMuRF-less patients also had a significantly reduced risk of in-hospital death when only adjusting for in-hospital treatment (RR: 0.78; 95% CI: 0.63-0.98; P = 0.030), regardless of patient characteristics. Conclusions Approximately 1 in 7 STEMI patients in China ≥75 years old had no SMuRFs. The similar mortality in patients with and without SMuRF can be partially explained by the inadequate in-hospital treatment of SMuRF-less patients. The quality of care for older patients without SMuRF should be improved. (CCC Project-Acture Coronary Syndrome; NCT02306616).
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Affiliation(s)
- Guanqi Zhao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mengge Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Xuedong Zhao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Arrhythmia Center, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - CCC-ACS Investigators
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
- Arrhythmia Center, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Li B, Chen L, Zheng M, Yan P, Wang L, Feng S, Yin W, Zhang K, Zhang S, Chen X, Wang Z, Yuan H. Supra-Normal Left Ventricular Ejection Fraction as a Prognostic Marker for Long-Term Outcomes in Patients with Acute Coronary Syndrome. Int Heart J 2023; 64:979-985. [PMID: 37967991 DOI: 10.1536/ihj.22-661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Recently, the supra-normal left ventricular ejection fraction (snLVEF) has been proposed, based on extensive datasets indicating increased all-cause mortality in individuals with an LVEF exceeding 65%. However, the implications of an LVEF > 65% in the context of acute coronary syndrome (ACS) remain underexplored.The aim of the present study was to investigate the correlation between supra-normal left ventricular ejection fraction (snLVEF) and major adverse cardiovascular events (MACE) in patients with ACS.Methods: A total of 874 ACS patients (560 men, mean age 59.5 ± 10.0; 314 women, mean age 61.5 ± 8.9) who underwent their first coronary angiography during the period from March 2013 to October 2015 were divided into 2 groups: normal LVEF (nLVEF) (55% ≤ EF ≤ 65%) and snLVEF (EF > 65%), according to their echocardiography results. The patients were evaluated for MACE after surgery by collecting clinical data and long-term follow-up data. This correlation was further analyzed by Kaplan-Meier analysis and Cox regression analysis.The follow-up data revealed a significantly higher incidence of MACE among snLVEF patients compared to the nLVEF group (15.6% versus 7.4%; P = 0.020). This heightened risk persisted even after adjustment for multiple variables, indicating a strong association between snLVEF and increased MACE risk (HR: 2.346; 95% CI: 1.196-4.602; P = 0.013).SnLVEF was independently associated with poor prognosis after ACS. Enhanced management strategies for snLVEF patients could potentially reduce the incidence of MACE in ACS patients.
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Affiliation(s)
- Baona Li
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
| | - Liuxin Chen
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Man Zheng
- Department of Cardiology, Dongying People's Hospital
| | - Pengcheng Yan
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
| | - Leiyan Wang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Shuai Feng
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Wenchao Yin
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
| | | | - Shaohui Zhang
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University
| | - Xueying Chen
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine
| | - Zhaoyang Wang
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Haitao Yuan
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
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Jing M, Xi H, Zhang M, Zhu H, Han T, Zhang Y, Deng L, Zhang B, Zhou J. Development of a nomogram based on pericoronary adipose tissue histogram parameters to differentially diagnose acute coronary syndrome. Clin Imaging 2023; 102:78-85. [PMID: 37639971 DOI: 10.1016/j.clinimag.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To develop a nomogram based on pericoronary adipose tissue (PCAT) histogram parameters to identify patients with acute coronary syndrome (ACS). MATERIALS AND METHODS This study retrospectively enrolled 114 and 383 eligible patients with ACS and stable coronary artery disease (CAD), respectively, and divided them into training and testing cohorts in a 7:3 ratio. A blinded radiologist obtained PCAT histogram parameters from the right coronary artery's proximal segment using fully automated software and compared clinical characteristics and PCAT histogram parameters between the two patient groups. The binary logistic regression included significant parameters (P < 0.05), and a nomogram was constructed. RESULTS In both the training and testing cohorts, the mean, 10th percentile, 90th percentile, median, and minimum values of PCAT were higher, and the interquartile range, skewness, and variance values of PCAT were lower in patients with ACS than in those with stable CAD (P ≤ 0.001). The mean (OR = 4.007), median (OR = 0.576), minimum (OR = 0.893), skewness (OR = 85,158.806) and variance (OR = 1.013) values of PCAT were independent risk factors for ACS and stable CAD in the training cohort. The nomogram was constructed using the five variables mentioned above with area under the curve values of 0.903 and 0.897, respectively, while the calibration and decision curves showed the nomogram's good clinical efficacy for the training and testing cohorts. CONCLUSIONS The constructed nomogram had good discrimination and accuracy and can be a noninvasive tool to intuitively and individually distinguish between ACS and stable CAD.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Meng Zhang
- Department of Gynecology, Lanzhou University Second Hospital, Lanzhou, China
| | - Hao Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Yuting Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Liangna Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Bin Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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Hu G, Gu H, Jiang Y, Yang X, Jiang Y, Wang C, Li Z, Wang Y, Wang Y. Revisiting the Smoking Paradox in Acute Ischemic Stroke Patients: Findings From the Chinese Stroke Center Alliance Study. J Am Heart Assoc 2023; 12:e029963. [PMID: 37548171 PMCID: PMC10492953 DOI: 10.1161/jaha.123.029963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/16/2023] [Indexed: 08/08/2023]
Abstract
Background Smoking is a well-established risk factor for the development of acute ischemic stroke (AIS). However, the "smoker's paradox" suggests that it is associated with favorable clinical outcomes following stroke. We aimed to reevaluate the association between smoking and in-hospital outcomes in patients with AIS in contemporary practice. Methods and Results A total of 649 610 inpatients with AIS from 1476 participating hospitals in the Chinese Stroke Center Alliance were included. In-hospital outcomes measurement included all-cause mortality, discharge against medical advice, and complications. Multivariable logistic regression models adjusting for baseline characteristics, clinical profiles at presentation, and in-hospital management were used to evaluate the association between smoking and in-hospital outcomes. A propensity score-matched analysis was also conducted. Of these patients with AIS, 36.8% (n=238 912) were smokers. Smokers were younger, had fewer comorbidities, and had slightly lower rates of adverse in-hospital outcomes than nonsmokers (all-cause death or discharge against medical advice: 6.0% versus 6.1%; in-hospital complications: 14.5% versus 15.1%). Multivariable analysis revealed that smoking was associated with higher risk of adverse in-hospital outcomes (all-cause death or discharge against medical advice: odds ratio [OR], 1.05 [95% CI, 1.02-1.08]; P<0.001; complications: OR, 1.06 [95% CI, 1.04-1.08]; P<0.001). The excess risk of adverse in-hospital outcomes remained in smoking patients with AIS after propensity score-matching analysis (all-cause death or discharge against medical advice: OR, 1.04 [95% CI, 1.00-1.08]; P=0.034; complications: OR, 1.05 [95% CI, 1.03-1.08]; P<0.001). Conclusions Smoking was associated with increased risk of adverse in-hospital outcomes among patients with AIS in contemporary practice, reinforcing the importance of smoking cessation in patients with AIS.
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Affiliation(s)
- Guoliang Hu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
- National Center for Neurological DiseasesBeijingChina
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xin Yang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yong Jiang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Chunjuan Wang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
- National Center for Neurological DiseasesBeijingChina
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
- National Center for Neurological DiseasesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
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Cadilhac DA, Bravata DM, Bettger JP, Mikulik R, Norrving B, Uvere EO, Owolabi M, Ranta A, Kilkenny MF. Stroke Learning Health Systems: A Topical Narrative Review With Case Examples. Stroke 2023; 54:1148-1159. [PMID: 36715006 PMCID: PMC10050099 DOI: 10.1161/strokeaha.122.036216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To our knowledge, the adoption of Learning Health System (LHS) concepts or approaches for improving stroke care, patient outcomes, and value have not previously been summarized. This topical review provides a summary of the published evidence about LHSs applied to stroke, and case examples applied to different aspects of stroke care from high and low-to-middle income countries. Our attempt to systematically identify the relevant literature and obtain real-world examples demonstrated the dissemination gaps, the lack of learning and action for many of the related LHS concepts across the continuum of care but also elucidated the opportunity for continued dialogue on how to study and scale LHS advances. In the field of stroke, we found only a few published examples of LHSs and health systems globally implementing some selected LHS concepts, but the term is not common. A major barrier to identifying relevant LHS examples in stroke may be the lack of an agreed taxonomy or terminology for classification. We acknowledge that health service delivery settings that leverage many of the LHS concepts do so operationally and the lessons learned are not shared in peer-reviewed literature. It is likely that this topical review will further stimulate the stroke community to disseminate related activities and use keywords such as learning health system so that the evidence base can be more readily identified.
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Affiliation(s)
- Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.A.C., M.F.K.)
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (D.A.C., M.F.K.)
| | - Dawn M Bravata
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.)
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.)
- Regenstrief Institute, Indianapolis, IN (D.M.B.)
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA (J.P.B.)
| | - Robert Mikulik
- International Clinical Research Centre, Neurology Department, St. Ann's University Hospital and Masaryk University, Brno, Czech Republic (R.M.)
- Health Management Institute, Czech Republic (R.M.)
| | - Bo Norrving
- Lund University, Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Sweden (B.N.)
| | - Ezinne O Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria (E.O.U., M.O.)
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria (E.O.U., M.O.)
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand (A.R.)
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.A.C., M.F.K.)
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (D.A.C., M.F.K.)
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Kasim S, Malek S, Cheen S, Safiruz MS, Ahmad WAW, Ibrahim KS, Aziz F, Negishi K, Ibrahim N. In-hospital risk stratification algorithm of Asian elderly patients. Sci Rep 2022; 12:17592. [PMID: 36266376 PMCID: PMC9584943 DOI: 10.1038/s41598-022-18839-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/22/2022] [Indexed: 01/13/2023] Open
Abstract
Limited research has been conducted in Asian elderly patients (aged 65 years and above) for in-hospital mortality prediction after an ST-segment elevation myocardial infarction (STEMI) using Deep Learning (DL) and Machine Learning (ML). We used DL and ML to predict in-hospital mortality in Asian elderly STEMI patients and compared it to a conventional risk score for myocardial infraction outcomes. Malaysia's National Cardiovascular Disease Registry comprises an ethnically diverse Asian elderly population (3991 patients). 50 variables helped in establishing the in-hospital death prediction model. The TIMI score was used to predict mortality using DL and feature selection methods from ML algorithms. The main performance metric was the area under the receiver operating characteristic curve (AUC). The DL and ML model constructed using ML feature selection outperforms the conventional risk scoring score, TIMI (AUC 0.75). DL built from ML features (AUC ranging from 0.93 to 0.95) outscored DL built from all features (AUC 0.93). The TIMI score underestimates mortality in the elderly. TIMI predicts 18.4% higher mortality than the DL algorithm (44.7%). All ML feature selection algorithms identify age, fasting blood glucose, heart rate, Killip class, oral hypoglycemic agent, systolic blood pressure, and total cholesterol as common predictors of mortality in the elderly. In a multi-ethnic population, DL outperformed the TIMI risk score in classifying elderly STEMI patients. ML improves death prediction by identifying separate characteristics in older Asian populations. Continuous testing and validation will improve future risk classification, management, and results.
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Affiliation(s)
- Sazzli Kasim
- grid.412259.90000 0001 2161 1343Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,grid.412259.90000 0001 2161 1343Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia ,grid.412259.90000 0001 2161 1343Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Sungai Buloh, Malaysia
| | - Sorayya Malek
- grid.10347.310000 0001 2308 5949Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Song Cheen
- grid.10347.310000 0001 2308 5949Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Shahreeza Safiruz
- grid.10347.310000 0001 2308 5949Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia ,grid.413018.f0000 0000 8963 3111Division of Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Khairul Shafiq Ibrahim
- grid.412259.90000 0001 2161 1343Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,grid.412259.90000 0001 2161 1343Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
| | - Firdaus Aziz
- grid.10347.310000 0001 2308 5949Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Kazuaki Negishi
- grid.1013.30000 0004 1936 834XSydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Sydney, NSW Australia ,grid.413243.30000 0004 0453 1183Nepean Hospital, Sydney, NSW Australia
| | - Nurulain Ibrahim
- grid.412259.90000 0001 2161 1343Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Sungai Buloh, Malaysia
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Chen Y, Ji M, Wu Y, Wang Q, Deng Y, Liu Y, Wu F, Liu M, Guo Y, Fu Z, Zheng X. An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis. JMIR Mhealth Uhealth 2021; 9:e26439. [PMID: 34898449 PMCID: PMC8713096 DOI: 10.2196/26439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/18/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system. Objective The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE. Methods We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China. Results iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90% (79/88) were satisfied with iCARE; 94% (83/88) and 82% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89% (54/61) were satisfied with the use of iCARE, 93% (57/61) perceived it as useful, and 70% (43/61) as easy to use. Conclusions This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients’ adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD. Trial Registration Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew
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Affiliation(s)
- Yuling Chen
- School of Nursing, Capital Medical University, Beijing, China
| | - Meihua Ji
- School of Nursing, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Qingyu Wang
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Deng
- School of Nursing, Capital Medical University, Beijing, China
| | - Yong Liu
- Along Technology Inc, Beijing, China
| | - Fangqin Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Mingxuan Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Yiqiang Guo
- School of Nursing, Capital Medical University, Beijing, China
| | - Ziyuan Fu
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiaoying Zheng
- The Asia-Pacific Economic Cooperation Health Science Academy, Peking University, Beijing, China.,Institute of Population Research, Peking University, Beijing, China
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