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Qamar A, Abramov D, Bang V, Chew NWS, Kobo O, Mamas MA. Has the first year of the COVID pandemic impacted the trends in obesity-related CVD mortality between 1999 and 2019 in the United States? Int J Cardiol Cardiovasc Risk Prev 2024; 21:200248. [PMID: 38590764 PMCID: PMC10999992 DOI: 10.1016/j.ijcrp.2024.200248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 11/12/2023] [Accepted: 02/16/2024] [Indexed: 04/10/2024]
Abstract
Background During the covid-19 pandemic there was a marked rise in the number of cardiovascular deaths. Obesity is a well-known modifiable risk factor for cardiovascular disease and has been identified as a factor which leads to poorer covid-19 related outcomes. In this study we aimed to analyse the impact of covid-19 on obesity-related cardiovascular deaths compared to trends seen 20 years prior. We also analysed the influence different demographics had on mortality. Methods Multiple Cause of Mortality database was accessed through CDC WONDER to obtain the obesity-related and general cardiovascular crude mortality and age adjusted mortality rates (AMMR) between 1999 and 2020 in the US. The obesity-related sample was stratified by demographics and cardiovascular mortality was subdivided into ischemic heart disease, heart failure, hypertension and cerebrovascular disease. Joinpoint Regression Program (Version 4.9.1.0) was used to calculate the average annual percent change (AAPC) in AAMR, and hence projected AAMR. Excess mortality was calculated by comparing actual AAMR in 2020 to projected values. Results and discussion There were an estimated 3058 excess deaths during the early stages of the pandemic impacting all cohorts. The greatest excess mortalities were seen in men, rural populations and in Asian/Pacific Islander and Native Americans. Interestingly the greatest overall mortality was seen in the Black American population. Our study highlights important, both pre and during the pandemic, in obesity related cardiovascular disease mortality which has important implications for ongoing public health measures.
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Affiliation(s)
- Afifa Qamar
- Lancashire Teaching Hospitals, Preston, England, United Kingdom
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda Health, Loma Linda, CA, USA
| | - Vijay Bang
- Lilavati Hospital and Research Center, Mumbai, India
| | - Nicholas WS. Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Israel
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
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Pan XH, Tan B, Chin YH, Lee ECZ, Kong G, Chong B, Kueh M, Khoo CM, Mehta A, Majety P, Grandhi GR, Dimitriadis GK, Foo R, Chew NWS, Le Roux CW, Mamas MA, Chan MY. Efficacy and safety of tirzepatide, GLP-1 receptor agonists, and other weight loss drugs in overweight and obesity: a network meta-analysis. Obesity (Silver Spring) 2024; 32:840-856. [PMID: 38413012 DOI: 10.1002/oby.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This network meta-analysis evaluates the efficacy and safety of tirzepatide compared to glucagon-like peptide-1 receptor agonists (GLP-1 RA) and other weight loss drugs in the treatment of overweight and obesity. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials on tirzepatide, GLP-1 RA, and weight loss drugs approved by the US Food and Drug Administration. A network meta-analysis was performed, drawing direct and indirect comparisons between treatment groups. Network diagrams and surface under the cumulative ranking curve analysis were performed for primary (≥5%, ≥10%, ≥15%, absolute weight loss) and secondary outcomes and adverse effects. RESULTS Thirty-one randomized controlled trials, involving more than 35,000 patients, were included in this study. Tirzepatide 15 mg ranked in the top three across weight-related parameters, glycemic profile (glycated hemoglobin), lipid parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides), and blood pressure. Tirzepatide 15 mg had the highest efficacy compared with placebo for achieving ≥15% weight loss (risk ratio 10.24, 95% CI: 6.42-16.34). As compared to placebo, tirzepatide and GLP-1 RA across all doses had significant increases in gastrointestinal adverse effects. CONCLUSIONS The superiority of tirzepatide and GLP-1 RA in inducing weight loss and their ability to target multiple metabolic parameters render them promising candidates in the treatment of patients with overweight and obesity.
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Affiliation(s)
- Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Martin Kueh
- Royal College of Surgeons in Ireland & University College Dublin Malaysia Campus, George Town, Malaysia
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Priyanka Majety
- Department of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Gowtham R Grandhi
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Carel W Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
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Mamas MA, Martin GP, Grygier M, Wadhera RK, Mallen C, Curzen N, Wijeysundera HC, Banerjee A, Kontopantelis E, Rashid M, Sielski J, Siudak Z. Indirect impact of the war in Ukraine on primary percutaneous coronary interventions for ST-elevation myocardial infarction in Poland. Pol Arch Intern Med 2024:16737. [PMID: 38661123 DOI: 10.20452/pamw.16737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The Russian invasion of Ukraine in February 2022 resulted in the displacement of approximately 12.5 million refugees to adjacent countries including Poland, that may have strained healthcare service delivery. OBJECTIVES Using the ST-elevation myocardial infarction (STEMI) data, we aimed to evaluate whether the Russian invasion of Ukraine has indirectly impacted the delivery of acute cardiovascular care in Poland. PATIENTS AND METHODS We analyzed all adult patients undergoing percutaneous coronary interventions (PCI) for STEMI across Poland between 25th February 2017 to 24th May 2022. Centers were allocated to regions of <100km and >100km of the Polish-Ukraine border. Mixed effect generalized linear regression models with random effects per hospital were used to explore the associations between the war in Ukraine starting with several outcomes of interest, and whether these associations differed across regions of >100km from the Polish-Ukraine border. RESULTS A total of 90,115 procedures were included in the analysis. The average number of procedures per-month was similar to predicted volume for centers in the >100km region, while the average number of PCI was higher than expected (by an estimated 15 (11-19)) for the <100km region. There was no difference in adjusted fatality rate or quality of care outcomes pre- vs. during-war in both <100 and >100 km regions, with no evidence of a difference-in-difference across regions. CONCLUSIONS Following the Russian invasion of Ukraine, there was only a modest and temporary increase in primary PCI predominantly in centers situated within 100km of the border, although no significant impact on in-hospital fatality rate.
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Sayed A, Abramov D, Fonarow GC, Mamas MA, Kobo O, Butler J, Fudim M. Reversals in the Decline of Heart Failure Mortality in the US, 1999 to 2021. JAMA Cardiol 2024:2817830. [PMID: 38656398 DOI: 10.1001/jamacardio.2024.0615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This cohort study evaluates recent reversals in declines in cardiovascular mortality and whether they vary across sociodemographic categories.
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Affiliation(s)
- Ahmed Sayed
- Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles
- Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-On-Trent, United Kingdom
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Javed Butler
- Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
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Wu B, Kheiwa A, Swamy P, Mamas MA, Tedford RJ, Alasnag M, Parwani P, Abramov D. Clinical Significance of Coronary Arterial Dominance: A Review of the Literature. J Am Heart Assoc 2024:e032851. [PMID: 38639360 DOI: 10.1161/jaha.123.032851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Coronary dominance describes the anatomic variation of coronary arterial supply, notably as it relates to perfusion of the inferior cardiac territories. Differences in the development and outcome in select disease states between coronary dominance patterns are increasingly recognized. In particular, observational studies have identified higher prevalence of poor outcomes in left coronary dominance in the setting of ischemic, conduction, and valvular disease. In this qualitative literature review, we summarize anatomic, physiologic, and clinical implications of differences in coronary dominance to highlight current understanding and gaps in the literature that should warrant further studies.
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Affiliation(s)
- Bovey Wu
- Department of Medicine Loma Linda University Medical Center Loma Linda CA USA
| | - Ahmed Kheiwa
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Pooja Swamy
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke-on-Trent United Kingdom
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Mirvat Alasnag
- Cardiac Center King Fahd Armed Forces Hospital Jeddah Saudi Arabia
| | - Purvi Parwani
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Dmitry Abramov
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
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Ajabnoor AM, Parisi R, Zghebi SS, Ashcroft DM, Faivre-Finn C, Morris C, Mamas MA, Kontopantelis E. Oral anticoagulant prescribing among patients with cancer and atrial fibrillation in England, 2009-2019. Cancer 2024; 130:1316-1329. [PMID: 38115738 DOI: 10.1002/cncr.35152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Anticoagulation of patients with atrial fibrillation (AF) and cancer is challenging because of their high risk for stroke and bleeding. Little is known of the variations of oral anticoagulant (OAC) prescribing in patients with AF with and without cancer. METHODS Patients with first-time AF during 2009-2019 from the Clinical Practice Research Datalink were included. Cancer diagnosis was defined as a history of breast, prostate, colorectal, lung, or hematological cancer. Competing-risk analysis was used to assess the risk of OAC prescribing in patients with AF and cancer adjusted for clinical and sociodemographic factors. RESULTS Of 177,065 patients with AF, 11.7% had cancer. Compared to patients without cancer, patients with cancer were less likely to receive OAC: prostate cancer (subhazard ratio [SHR], 0.95; 95% CI, 0.91-0.99), breast cancer (SHR, 0.93; 95% CI, 0.89-0.98), colorectal cancer (SHR, 0.93; 95% CI, 0.88-0.99), hematological cancer (SHR, 0.70; 95% CI, 0.65-0.75), and lung cancer (SHR, 0.44; 95% CI, 0.38-0.50). The cumulative incidence function (CIF) of OAC prescribing was lowest for patients with lung cancer and hematological cancer compared with patients without cancer. The difference between the CIF of OAC prescribing in patients with and without cancer becomes narrower in the most deprived areas. Elderly patients (aged ≥85 years) overall had the lowest CIF of OAC prescribing regardless of cancer status. CONCLUSIONS In patients with AF, underprescribing of OAC is independently associated with certain cancer types. Patients with hematological and lung cancer are the least likely to receive anticoagulation therapy compared with patients without cancer. Underprescribing of OAC in cancer is linked to old age. Further studies of patients with AF and cancer are warranted to assess the net clinical benefit of anticoagulation in certain cancer types.
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Affiliation(s)
- Alyaa M Ajabnoor
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Salwa S Zghebi
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR), Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, UK
| | - Corinne Faivre-Finn
- Christie National Health Service Foundation Trust and University of Manchester, Manchester, UK
| | - Charlotte Morris
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Ibrahim R, Lin L, Sainbayar E, Pham HN, Shahid M, Le Cam E, William P, Ferreira JP, Alkindi S, Mamas MA. Influence of Social Vulnerability Index on Medicare Beneficiaries' Expenditures upon Discharge. J Investig Med 2024:10815589241247791. [PMID: 38591746 DOI: 10.1177/10815589241247791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Medicare beneficiaries' healthcare spending varies across geographical regions, influenced by availability of medical resources and institutional efficiency. We aimed to evaluate whether social vulnerability influences healthcare costs among Medicare beneficiaries. Multivariable regression analyses were conducted to determine whether the social vulnerability index (SVI), released by the CDC, was associated with average submitted covered charges, total payment amounts, or total covered days upon hospital discharge among Medicare beneficiaries. We used information from discharged Medicare beneficiaries from hospitals participating in the Inpatient Prospective Payment System. Covariate adjustment included demographic information consisting of age groups, race/ethnicity, and Hierarchical Condition Category risk score. The regressions were performed with weights proportioned to the number of discharges. Average submitted covered charges significantly correlated with SVI (β=0.50, p<0.001) in the unadjusted model and remained significant in the covariates-adjusted model (β=0.25, p=0.039). The SVI was not significantly associated with the total payment amounts (β=-0.07, p=0.238) or the total covered days (β=0.00, p=0.953) in the adjusted model. Regional variations in Medicare beneficiaries' healthcare spending exist and are influenced by levels of social vulnerability. Further research is warranted to fully comprehend the impact of social determinants on healthcare costs.
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Affiliation(s)
- Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | | | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Mahek Shahid
- University of Arizona Medical Center - University Campus, Tucson, United States
| | - Elise Le Cam
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Preethi William
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Sadeer Alkindi
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist Debakey Heart and Vascular Center, Houston, TX
- Center for Cardiovascular Computational and Precision Health, Houston Methodist, Houston, TX
- Houston Methodist Academic Institute, Houston Methodist, Houston TX
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
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Kobo O, Levi Y, Abu-Fanne R, Von Birgelen C, Guédès A, Aminian A, Laanmets P, Dewilde W, Witkowski A, Monsegu J, Romo Iniguez A, Halabi M, Mamas MA, Roguin A. Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry. Int J Cardiol Heart Vasc 2024; 51:101370. [PMID: 38628296 PMCID: PMC11018637 DOI: 10.1016/j.ijcha.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
Aims A substantial proportion of the patients undergoing percutaneous coronary intervention (PCI) have none of the of standard modifiable cardiovascular risk factors (SMuRFs): hypertension, diabetes, hypercholesterolaemia and smoking. The aim of this analysis was to compare clinical outcomes after PCI according to the number of SMuRFs. Methods Patients with an indication for a PCI were stratified based upon the number of SMuRFs: 0, 1, 2 or 3-4. The primary outcome was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction or clinically driven target lesion revascularization at 1-year. Inverse weighted propensity score (IWPS) adjustment was performed to adjust for differences in baseline characteristics. Results The prevalence of SMuRFs was: 0 SMuRF 16.4 %; 1 SMuRF 27.8 %; 2 SMuRFs 34.7 % and 3-4 SMuRFs 21.1 %. Patients without SMuRFs were younger, more likely to be male and had less complex coronary artery disease. The incidence of TLF increased with the number of SMuRFs: 2.65 %, 2.75 %, 3.23 %, and 4.24 %, Ptrend < 0.001. The relative risk (RR) for a TLF was 60 % higher (95 % confidence interval 1.32-1.93, p < 0.01) for patients with 3-4 SMuRFs compared to patients without SMuRFs. The trend remained (Ptrend < 0.01) after IWPS with TLF rates of 2.88 %, 2.64 %, 2.88 % and 3.65 %. The RR for a TLF was 27 % higher (95 % CI 1.05-1.53, p < 0.01). Conclusion The incidence of clinical events at 1-year increased with the number of SMuRFs. While patients without SMuRFs have a relatively favourable risk profile, more research is needed to optimize therapeutic management in the majority of patients.
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Affiliation(s)
- Ofer Kobo
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Yaniv Levi
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Rami Abu-Fanne
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Clemens Von Birgelen
- Thoraxcentrum Twente, Medisch Spectrum Twente, and Department Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Antoine Guédès
- CHU UCL Namur, Site de Mont Godinne, Université catholique de Louvain, Belgium
| | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Peep Laanmets
- North Estonia Medical Center Foundation, Tallinn, Estonia
| | | | | | - Jacques Monsegu
- Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
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Walters B, Midwinter I, Chew-Graham CA, Jordan KP, Sharma G, Chappell LC, Crosbie EJ, Parwani P, Mamas MA, Wu P. Pregnancy-Associated Cancer: A Systematic Review and Meta-Analysis. Mayo Clin Proc Innov Qual Outcomes 2024; 8:188-199. [PMID: 38524280 PMCID: PMC10957385 DOI: 10.1016/j.mayocpiqo.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
This study aimed to systematically evaluate and quantify the risk of adverse maternal and neonatal outcomes in patients with pregnancy-associated cancer (PAC). This study was conducted from February 13, 2021, through July 24, 2023. A systematic search of MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials was conducted to identify studies reporting outcomes for patients with PAC. The study was registered on PROSPERO. Two reviewers independently conducted screening, data extraction, and quality assessment. The associations were quantified using random-effects meta-analysis. The initial search produced 29,401 titles and abstracts, after which 147 unique full-text articles were screened, of which 22 articles with 59,190 pregnancies with PAC from 70,097,167 births were included in the meta-analysis. Women with PAC were at significantly increased risk of cesarean deliveries (risk ratio [RR], 1.58; 95% CI, 1.31-1.89), preterm birth (RR, 3.07; 95% CI, 2.37-3.98), venous thromboembolism (RR, 6.76; 95% CI, 5.08-8.99), and maternal death (RR, 41.58; 95% CI, 20.38-84.83). The only outcome with reduced risk was instrumental mode of delivery (RR, 0.67; 95% CI, 0.52-0.87). Pregnancy-associated cancer increases risk of adverse outcomes, including a 7-fold risk of venous thromboembolism and a 42-fold risk of maternal death. Further research is required to better understand the mechanisms leading to these adverse outcomes, especially for women who are not diagnosed until the postpartum period. Affected women should have counseling regarding their increased risk of adverse outcomes.
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Affiliation(s)
- Ben Walters
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
| | - India Midwinter
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
| | - Carolyn A. Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Kelvin P. Jordan
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lucy C. Chappell
- School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Emma J. Crosbie
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA
| | - Mamas A. Mamas
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Pensée Wu
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nobre Menezes M, Mamas MA. PCI in Cancer Patients: Adding Another Piece to a Complex and Still Very Incomplete Puzzle. Circ Cardiovasc Interv 2024; 17:e014076. [PMID: 38626081 DOI: 10.1161/circinterventions.124.014076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Miguel Nobre Menezes
- Structural and Coronary Heart Disease Unit, Cardio-Oncology Unit CHULN Hospital de Santa Maria, Cardiovascular Center of the University of Lisbon (CCUL@RISE), Universidade de Lisboa, Lisbon, Portugal (M.N.M.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom (M.A.M.)
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Etherington C, Boet S, Chen I, Duffy M, Mamas MA, Bader Eddeen A, Bateman BT, Sun LY. Association Between Surgeon/Anesthesiologist Sex Discordance and 1-year Mortality Among Adults Undergoing Noncardiac Surgery: A Population-based Retrospective Cohort Study. Ann Surg 2024; 279:563-568. [PMID: 37791498 DOI: 10.1097/sla.0000000000006111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To investigate the association between surgeon-anesthesiologist sex discordance and patient mortality after noncardiac surgery. BACKGROUND Evidence suggests different practice patterns exist among female and male physicians. However, the influence of physician sex on team-based practices in the operating room and subsequent patient outcomes remains unclear in the context of noncardiac surgery. METHODS We conducted a population-based, retrospective cohort study of adult Ontario residents who underwent index, inpatient noncardiac surgery between January 2007 and December 2017. The primary exposure was physician sex discordance (ie, the surgeon and anesthesiologist were of the opposite sex). The primary outcome was 1-year mortality. The association between physician sex discordance and patient outcomes was modeled using multivariable Cox proportional hazard regression with adjustment for relevant physician, patient, and hospital characteristics. RESULTS Of 541,209 patients, 158,084 (29.2%) were treated by sex-discordant physician teams. Physician sex discordance was associated with a lower rate of mortality at 1 year [5.2% vs. 5.7%; adjusted HR: 0.95 (0.91-0.99)]. Patients treated by teams composed of female surgeons and male anesthesiologists were more likely to be alive at 1 year than those treated by all-male physician teams [adjusted HR: 0.90 (0.81-0.99)]. CONCLUSIONS Noncardiac surgery patients had a lower likelihood of 1-year mortality when treated by sex-discordant surgeon-anesthesiologist teams. The likelihood of mortality was further reduced if the surgeon was female. Further research is needed to explore the underlying mechanisms of these observations and design strategies to diversify operating room teams to optimize performance and patient outcomes.
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Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Innie Chen
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Melissa Duffy
- Department of Educational Studies, University of South Carolina, Columbia, SC
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
| | | | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Louise Y Sun
- Institute for Clinical Evaluative Sciences, ON, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Elkaryoni A, Darki A, Bunte M, Mamas MA, Weinberg I, Elgendy IY. Palliative Care Penetration Among Hospitalizations with Acute Pulmonary Embolism: A Nationwide Analysis. J Palliat Care 2024; 39:129-137. [PMID: 35138196 DOI: 10.1177/08258597221078389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Integration of palliative care in the management of critical illnesses has been linked with a better quality of life for patients and their families. Yet, there is a paucity of data regarding the role of palliative care for acute pulmonary embolism (PE) hospitalizations which is a leading cause of cardiovascular death in the United States. Methods: Using the Nationwide Inpatient Sample years 2005-2015, acute PE hospitalizations were identified by using ICD-9-codes. The primary outcome was the trends of palliative care penetration during acute PE hospitalizations and the main secondary outcome was the factors associated with palliative care utilization. Results: Among 505,485 acute PE hospitalizations, 15,522 (3.1%) had a palliative care encounter. Hospitalizations with high-risk PE versus non-high-risk PE showed a higher utilization for palliative care (7.6% vs. 2.7%, P < 0.001). The annual trends of palliative care penetration among hospitalizations with PE showed a rising pattern (0.6% in 2005 vs. 5.6% in 2015, Ptrend<0.001). A similar trend was observed among those with high-risk PE (0.8% in 2005 vs. 12.8% in 2015, Ptrend<0.001). The trends of palliative care utilization among cancer and non-cancer admissions increased over time (1.3%in 2005 to 15.5% in 2015 vs. 0.5% in 2005 to 3.9% in 2015, both P-trends<0.001). Some racial and regional disparities were identified among the predictors of palliative care utilization. Conclusions: Palliative care penetration among acute PE hospitalizations remains suboptimal even among high-risk PE, and cancer hospitalizations, but has been increasing in recent years. Future studies are needed to investigate the barriers for palliative care utilization and narrowing this gap among admissions with acute PE.
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Affiliation(s)
| | - Amir Darki
- Loyola Stritch School of Medicine, Maywood, IL, USA
| | - Matthew Bunte
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas, MO, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | | | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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13
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Dawson LP, Rashid M, Dinh DT, Brennan A, Bloom JE, Biswas S, Lefkovits J, Shaw JA, Chan W, Clark DJ, Oqueli E, Hiew C, Freeman M, Taylor AJ, Reid CM, Ajani AE, Kaye DM, Mamas MA, Stub D. No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score. Circ Cardiovasc Interv 2024; 17:e013738. [PMID: 38487882 DOI: 10.1161/circinterventions.123.013738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Suboptimal coronary reperfusion (no reflow) is common in acute coronary syndrome percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate a clinical risk score for angiographic no reflow for use following angiography and before PCI. METHODS We developed and externally validated a logistic regression model for prediction of no reflow among adult patients undergoing PCI for acute coronary syndrome using data from the Melbourne Interventional Group PCI registry (2005-2020; development cohort) and the British Cardiovascular Interventional Society PCI registry (2006-2020; external validation cohort). RESULTS A total of 30 561 patients (mean age, 64.1 years; 24% women) were included in the Melbourne Interventional Group development cohort and 440 256 patients (mean age, 64.9 years; 27% women) in the British Cardiovascular Interventional Society external validation cohort. The primary outcome (no reflow) occurred in 4.1% (1249 patients) and 9.4% (41 222 patients) of the development and validation cohorts, respectively. From 33 candidate predictor variables, 6 final variables were selected by an adaptive least absolute shrinkage and selection operator regression model for inclusion (cardiogenic shock, ST-segment-elevation myocardial infarction with symptom onset >195 minutes pre-PCI, estimated stent length ≥20 mm, vessel diameter <2.5 mm, pre-PCI Thrombolysis in Myocardial Infarction flow <3, and lesion location). Model discrimination was very good (development C statistic, 0.808; validation C statistic, 0.741) with excellent calibration. Patients with a score of ≥8 points had a 22% and 27% risk of no reflow in the development and validation cohorts, respectively. CONCLUSIONS The no-reflow prediction in acute coronary syndrome risk score is a simple count-based scoring system based on 6 parameters available before PCI to predict the risk of no reflow. This score could be useful in guiding preventative treatment and future trials.
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Affiliation(s)
- Luke P Dawson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
- Department of Cardiovascular Sciences, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, United Kingdom (M.R., A.E.A.)
- University Hospitals of Leicester National Health Service (NHS) Trust, United Kingdom (M.R., A.E.A.)
| | - Diem T Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Jason E Bloom
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia (J.L.)
| | - James A Shaw
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - William Chan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Medicine, Melbourne University, Victoria, Australia (W.C.)
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (D.J.C.)
| | - Ernesto Oqueli
- Department of Cardiology, Grampians Health Ballarat, Victoria, Australia (E.O.)
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia (E.O.)
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Victoria, Australia (C.H.)
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia (M.F.)
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Centre of Clinical Research and Education, School of Public Health, Curtin University, Perth, Western Australia, Australia (C.M.R.)
| | - Andrew E Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
- Department of Cardiovascular Sciences, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, United Kingdom (M.R., A.E.A.)
- University Hospitals of Leicester National Health Service (NHS) Trust, United Kingdom (M.R., A.E.A.)
| | - David M Kaye
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.)
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.)
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.)
- The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.)
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Licordari R, Costa F, Garcia-Ruiz V, Mamas MA, Marquis-Gravel G, de la Torre Hernandez JM, Gomez Doblas JJ, Jimenez-Navarro M, Rodriguez-Capitan J, Urbano-Carrillo C, Ortega-Paz L, Piccolo R, Versace AG, Di Bella G, Andò G, Angiolillo DJ, Valgimigli M, Micari A. The Evolving Field of Acute Coronary Syndrome Management: A Critical Appraisal of the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndrome. J Clin Med 2024; 13:1885. [PMID: 38610650 PMCID: PMC11012418 DOI: 10.3390/jcm13071885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Acute coronary syndromes (ACS), encompassing conditions like ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndromes (NSTE-ACS), represent a significant challenge in cardiovascular care due to their complex pathophysiology and substantial impact on morbidity and mortality. The 2023 European Society of Cardiology (ESC) guidelines for ACS management introduce several updates in key areas such as invasive treatment timing in NSTE-ACS, pre-treatment strategies, approaches to multivessel disease, and the use of imaging modalities including computed tomography (CT) coronary angiography, magnetic resonance imaging (MRI), and intracoronary imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). They also address a modulation of antiplatelet therapy, taking into consideration different patient risk profiles, and introduce new recommendations for low-dose colchicine. These guidelines provide important evidence-based updates in practice, reflecting an evolution in the understanding and management of ACS, yet some potentially missed opportunities for more personalized care and technology adoption are discussed.
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Affiliation(s)
- Roberto Licordari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (R.L.); (A.M.)
| | - Francesco Costa
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (R.L.); (A.M.)
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, UK;
| | - Guillaume Marquis-Gravel
- Montréal Heart Institute, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada;
| | | | - Juan Jose Gomez Doblas
- Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, Departamento de Medicina UMA, 29010 Malaga, Spain; (J.J.G.D.); (M.J.-N.); (J.R.-C.)
| | - Manuel Jimenez-Navarro
- Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, Departamento de Medicina UMA, 29010 Malaga, Spain; (J.J.G.D.); (M.J.-N.); (J.R.-C.)
| | - Jorge Rodriguez-Capitan
- Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, Departamento de Medicina UMA, 29010 Malaga, Spain; (J.J.G.D.); (M.J.-N.); (J.R.-C.)
| | | | - Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA (D.J.A.)
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy;
| | | | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (G.D.B.); (G.A.)
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (G.D.B.); (G.A.)
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA (D.J.A.)
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6500 Lugano, Switzerland;
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (R.L.); (A.M.)
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15
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Bashar H, Kobo O, Curzen N, Mamas MA. Association of myocardial injury with adverse long-term survival among cancer patients. Eur J Prev Cardiol 2024:zwae116. [PMID: 38512003 DOI: 10.1093/eurjpc/zwae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 03/22/2024]
Abstract
AIMS Over time, cardiovascular disease (CVD) deaths increasingly exceed those from malignancy among cancer survivors. However, the association of myocardial injury with long-term survival (beyond three years) in cancer patients has not been previously described. METHODS The National Health and Nutrition Examination Survey high-sensitivity cardiac troponin (hs-cTn) and morbidities databases (1999-2004) were linked with the latest mortality dataset isolating records were respondents reported cancer diagnosis by a healthcare professional. Myocardial injury was then determined by elevated hs-cTn. RESULTS 16,225,560 weighted records (1,058 unweighted) were included in this observational study, with myocardial injury identified in 14·2%. Those with myocardial injury had progressively worse survival at 5 (51·6% vs. 89·5%), 10 (28·3% vs. 76·0%), and 15 years (12·6% vs. 61·4%) compared to those without myocardial injury. After adjusting for baseline characteristics, those with myocardial injury had an adjusted hazard ratio (aHR) of 2·10 (95% CI 2·09-2·10, p<0·001) for all-cause mortality, 2·23 (2·22-2·24, p<0·001) for cardiovascular mortality, and 1·59 (95% CI 1·59-1·60, p<0·001) for cancer mortality compared to those without myocardial injury. Among patients with no pre-existing CVD, the hs-cTn I Ortho assay was a strong independent predictor of all cause (aHR 6·29, 95% CI 6·25-6·33, p<0·001), CVD (aHR 11·38, 95% CI 11·23-11·54, p<0·001), and cancer (aHR 5·02, 95% CI 4·96-5·07, p<0·001) mortality. CONCLUSIONS As a marker for myocardial injury, hs-cTn/s were independently associated with worse long-term survival among cancer patients with a stronger relationship with all-cause, cardiovascular, and cancer mortality using hs-cTn I ortho assay.
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Affiliation(s)
- Hussein Bashar
- Faculty of Medicine, University of Southampton, United Kingdom
- The Coronary Research Group, University Hospital Southampton NHS Foundation Trust, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, United Kingdom
- The Coronary Research Group, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
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Rivera FB, Cha SW, Liston MB, Redula S, Bantayan NRB, Shah N, Mamas MA, Volgman AS. Sex differences in trends and in-hospital outcomes of acute myocardial infarction in patients with familial hypercholesterolemia: insights from a large national database. Expert Rev Cardiovasc Ther 2024:1-8. [PMID: 38459907 DOI: 10.1080/14779072.2024.2329720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/08/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Sex differences in clinical outcomes following acute myocardial infarction (AMI) are well known. However, data on sex differences among patients with familial hypercholesterolemia (FH) are limited. We aimed to explore sex differences in outcomes of AMI among patients with FH from a national administrative dataset. RESEARCH DESIGN AND METHODS We utilized the National Inpatient Sample to identify admissions with a primary diagnosis of AMI and a secondary diagnosis of FH. Our primary outcome of interest was in-hospital mortality; secondary outcomes were performance of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), respiratory complications, use of inotropes, use of mechanical circulatory support (MCS), bleeding complications, transfusion and facility discharge. We adjusted for demographics (model A), comorbidities (model B), and intervention (model C). RESULTS Between October 2016 and December 2020, 5,714,993 admissions with a primary diagnosis of AMI were identified, of which 3,035 (0.05%) had a secondary diagnosis of FH. In-hospital mortality did not differ between men and women (Model C, adjusted OR = 0.85; 95% CI 0.28-2.60, p = 0.773). There was no sex difference in the secondary outcomes. CONCLUSION Despite generally being older and having more comorbidities, women with FH fair equally with men with FH in terms of mortality during AMI admission.
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Affiliation(s)
| | | | | | - Sonny Redula
- Cebu Institute of Medicine, Cebu City, Philippines
| | - Nathan Ross B Bantayan
- University of the Philippines College of Medicine - Philippine General Hospital, Manila, Philippines
| | - Nishant Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
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17
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Miranda RN, Qiu F, Manoragavan R, Austin PC, Naimark DMJ, Fremes SE, Ko DT, Madan M, Mamas MA, Sud MK, Tam D, Wijeysundera HC. Transcatheter Aortic Valve Implantation Wait-Time Management: Derivation and Validation of the Canadian TAVI Triage Tool (CAN3T). J Am Heart Assoc 2024; 13:e033768. [PMID: 38390797 PMCID: PMC10944064 DOI: 10.1161/jaha.123.033768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has seen indication expansion and thus exponential growth in demand over the past decade. In many jurisdictions, the growing demand has outpaced capacity, increasing wait times and preprocedural adverse events. In this study, we derived prediction models that estimate the risk of adverse events on the waitlist and developed a triage tool to identify patients who should be prioritized for TAVI. METHODS AND RESULTS We included adult patients in Ontario, Canada referred for TAVI and followed up until one of the following events first occurred: death, TAVI procedure, removal from waitlist, or end of the observation period. We used subdistribution hazards models to find significant predictors for each of the following outcomes: (1) all-cause death while on the waitlist; (2) all-cause hospitalization while on the waitlist; (3) receipt of urgent TAVI; and (4) a composite outcome. The median predicted risk at 12 weeks was chosen as a threshold for a maximum acceptable risk while on the waitlist and incorporated in the triage tool to recommend individualized wait times. Of 13 128 patients, 586 died while on the waitlist, and 4343 had at least 1 hospitalization. A total of 6854 TAVIs were completed, of which 1135 were urgent procedures. We were able to create parsimonious models for each outcome that included clinically relevant predictors. CONCLUSIONS The Canadian TAVI Triage Tool (CAN3T) is a triage tool to assist clinicians in the prioritization of patients who should have timely access to TAVI. We anticipate that the CAN3T will be a valuable tool as it may improve equity in access to care, reduce preventable adverse events, and improve system efficiency.
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Affiliation(s)
- Rafael N. Miranda
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
| | | | - Ragavie Manoragavan
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
| | - Peter C. Austin
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESTorontoCanada
| | - David M. J. Naimark
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Stephen E. Fremes
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Dennis T. Ko
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Mina Madan
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, School of MedicineKeele UniversityStoke‐on‐TrentUnited Kingdom
| | - Maneesh K. Sud
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
| | - Derrick Tam
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
| | - Harindra C. Wijeysundera
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
- ICESTorontoCanada
- Schulich Heart Program, Sunnybrook Health Sciences CentreUniversity of TorontoCanada
- Temerty Faculty of MedicineUniversity of TorontoCanada
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18
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Abramov D, Kobo O, Mamas MA. Association of Cardiovascular Health Metrics and Mortality Among Individuals With and Without Cancer. J Am Heart Assoc 2024; 13:e032683. [PMID: 38390816 PMCID: PMC10944047 DOI: 10.1161/jaha.123.032683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Although metrics of cardiovascular health have been associated with improved mortality, whether the association remains among individuals with a history of cancer has not been well characterized. METHODS AND RESULTS The National Health and Nutrition Examination Survey data from 2009 to 2018 were used to identify individuals with and without a history of cancer. For each participant, American Heart Association Life's Essential 8 cardiovascular health metrics of health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure) were obtained. All-cause, cardiovascular, and cancer-related mortality were noted. Out of 21 967 individuals, 8% had a history of cancer. In analyses adjusted for age, race and ethnicity, sex, and income among the whole cohort, better Life's Essential 8 cardiovascular health metrics were associated with lower all-cause (adjusted hazard ratio [aHR ], 0.38 [95% CI, 0.29-0.49]; P<0.001), cardiovascular (aHR, 0.38 [95% CI, 0.22-0.49]; P<0.001), and cancer mortality (aHR, 0.50 [95% CI, 0.31-0.79]; P=0.001). This association was driven by better health behaviors that were associated with lower all-cause (aHR, 0.30 [95% CI, 0.26-0.35]; P<0.001), cardiovascular (aHR, 0.39 [95% CI, 0.26-0.52]; P<0.001), and cancer mortality (aHR, 0.35 [95% CI, 0.26-0.47]; P<0.001), whereas better health factors were not associated with lower mortality. There were no significant interactions in these associations between individuals with and without cancer. CONCLUSIONS Better metrics of cardiovascular health, particularly health behaviors, are associated with improved all-cause, cardiovascular, and cancer mortality to a similar extent in individuals with and without cancer. Attempts to improve cardiovascular health should be prioritized similarly among individuals with and without cancer.
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Affiliation(s)
- Dmitry Abramov
- Division of Cardiology, Department of MedicineLoma Linda University HealthLoma LindaCAUSA
| | - Ofer Kobo
- Department of CardiologyHillel Yaffe Medical CenterHaderaIsrael
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
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Remfry E, Ardissino M, McCracken C, Szabo L, Neubauer S, Harvey NC, Mamas MA, Robson J, Petersen SE, Raisi-Estabragh Z. Sex-based differences in risk factors for incident myocardial infarction and stroke in the UK Biobank. Eur Heart J Qual Care Clin Outcomes 2024; 10:132-142. [PMID: 37218687 PMCID: PMC10904726 DOI: 10.1093/ehjqcco/qcad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/31/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
AIM This study examined sex-based differences in associations of vascular risk factors with incident cardiovascular events in the UK Biobank. METHODS Baseline participant demographic, clinical, laboratory, anthropometric, and imaging characteristics were collected. Multivariable Cox regression was used to estimate independent associations of vascular risk factors with incident myocardial infarction (MI) and ischaemic stroke for men and women. Women-to-men ratios of hazard ratios (RHRs), and related 95% confidence intervals, represent the relative effect-size magnitude by sex. RESULTS Among the 363 313 participants (53.5% women), 8470 experienced MI (29.9% women) and 7705 experienced stroke (40.1% women) over 12.66 [11.93, 13.38] years of prospective follow-up. Men had greater risk factor burden and higher arterial stiffness index at baseline. Women had greater age-related decline in aortic distensibility. Older age [RHR: 1.02 (1.01-1.03)], greater deprivation [RHR: 1.02 (1.00-1.03)], hypertension [RHR: 1.14 (1.02-1.27)], and current smoking [RHR: 1.45 (1.27-1.66)] were associated with a greater excess risk of MI in women than men. Low-density lipoprotein cholesterol was associated with excess MI risk in men [RHR: 0.90 (0.84-0.95)] and apolipoprotein A (ApoA) was less protective for MI in women [RHR: 1.65 (1.01-2.71)]. Older age was associated with excess risk of stroke [RHR: 1.01 (1.00-1.02)] and ApoA was less protective for stroke in women [RHR: 2.55 (1.58-4.14)]. CONCLUSION Older age, hypertension, and smoking appeared stronger drivers of cardiovascular disease in women, whereas lipid metrics appeared stronger risk determinants for men. These findings highlight the importance of sex-specific preventive strategies and suggest priority targets for intervention in men and women.
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Affiliation(s)
- Elizabeth Remfry
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Maddalena Ardissino
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London SW3 6LY, UK
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Semmelweis University, Heart and Vascular Center, Hungary, Budapest 1122, Hungary
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield EC1A 7BE, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, UK
- Institute of Population Health, University of Manchester, Manchester M13 9NT, UK
| | - John Robson
- Wolfson Institute of Population Health Sciences, Queen Mary University of London, London E1 4NS, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield EC1A 7BE, UK
- Health Data Research UK, London NW1 2BE, UK
- Alan Turing Institute, London NW1 2DB, UK
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield EC1A 7BE, UK
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Pant A, Chew DP, Mamas MA, Zaman S. Cardiovascular Disease and the Mediterranean Diet: Insights into Sex-Specific Responses. Nutrients 2024; 16:570. [PMID: 38398894 PMCID: PMC10893368 DOI: 10.3390/nu16040570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes.
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Affiliation(s)
- Anushriya Pant
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia;
| | - Derek P. Chew
- Victorian Heart Hospital, Victorian Heart Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Newcastle ST5 5BG, UK
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia;
- Department of Cardiology, Westmead Hospital, Sydney, NSW 2145, Australia
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21
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Mamas MA. Cutting tall poppies down to size lessons from the tyrants of ancient Rome. Eur Heart J 2024; 45:498-499. [PMID: 37897339 DOI: 10.1093/eurheartj/ehad708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Affiliation(s)
- Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, David Weatherall Building, Keele University, Keele, Newcastle ST5 5BG, UK
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22
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Weight N, Moledina S, Hennessy T, Jia H, Banach M, Rashid M, Siller-Matula JM, Thiele H, Mamas MA. The quality of care and long-term mortality of out of hospital cardiac arrest survivors after acute myocardial infarction: a nationwide cohort study. Eur Heart J Qual Care Clin Outcomes 2024:qcae015. [PMID: 38366628 DOI: 10.1093/ehjqcco/qcae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND The long-terms outcomes of out of hospital cardiac arrest (OHCA) survivors are not well known. METHODS Using the Myocardial Ischaemia National Audit Project (MINAP) registry, linked to Office for National Statistics (ONS) mortality data, we analysed 661 326 England, Wales and Northern-Ireland AMI patients; 14 127 (2%) suffered OHCA and survived beyond thirty-days of hospitalisation. Patients dying within thirty-days of admission were excluded. Mean follow-up for patients included was 1 500 days. Cox regression models were fitted, adjusting for demographics and management strategy. RESULTS OHCA survivors were younger (in years) (64 (interquartile range [IQR] 54-72) vs. 70 (IQR 59-80), P < 0.001), more often underwent invasive coronary angiography (88% vs. 71%, P < 0.001) and percutaneous coronary intervention (72% vs. 45%, P < 0.001). Overall, risk of mortality for OHCA patients that survived past 30-days was lower than patients that did not suffer cardiac arrest (adjusted hazard ratio [HR] 0.91; 95% CI; 0.87-0.95, P < 0.001). 'Excellent care' according to the mean opportunity-based quality indicator (OBQI) score compared to 'Poor care', predicted reduced risk of long-term mortality post OHCA, for all-patients (HR: 0.77, CI; 0.76-0.78, P < 0.001), more for STEMI patients (HR: 0.73, CI; 0.71-0.75, P < 0.001), but less significantly in NSTEMI patients (HR: 0.79, CI; 0.78-0.81, P < 0.001). CONCLUSIONS Out of hospital cardiac arrest (OHCA) patients remain at significant risk of mortality in-hospital. However, if surviving over thirty-days post arrest, OHCA survivors have good longer-term survival up to ten-years compared to the general AMI population. Higher quality inpatient care appears to improve long-term survival in all OHCA patients, more so in STEMI.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (UK)
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (UK)
| | - Tommy Hennessy
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (UK)
| | - Haibo Jia
- Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education/Harbin 150086, P. R. China
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Rzgowska 281/289, 93-338 Lodz, Poland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD 21287, USA
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (UK)
| | - Jolanta M Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany and Leipzig Heart Science, Leipzig, Germany
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (UK)
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23
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Sharma V, Choudhury A, Basavarajaiah S, Rashid M, Yuan M, Jefferey D, Vanezis AP, Sall H, Smith WHT, Parasa R, Kelly P, Kinnaird T, Mamas MA. Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study. Cardiovasc Revasc Med 2024:S1553-8389(24)00049-6. [PMID: 38395628 DOI: 10.1016/j.carrev.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort. BACKGROUND There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO. METHODS Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes. RESULTS There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42-4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25-2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10-0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %. CONCLUSIONS In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes.
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Affiliation(s)
- Vinoda Sharma
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland; University of Birmingham, United Kingdom of Great Britain and Northern Ireland.
| | - Anirban Choudhury
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Sandeep Basavarajaiah
- Heartlands Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Muhammad Rashid
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Mengshi Yuan
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Jefferey
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Andrew P Vanezis
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Hanish Sall
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - William H T Smith
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Ramya Parasa
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Paul Kelly
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Tim Kinnaird
- University Hospital Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Mamas A Mamas
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
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24
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Kobo O, Michos ED, Roguin A, Bagur R, Gulati M, Mamas MA. Recommended and observed statin use among US adults with and without cancer. Eur J Prev Cardiol 2024:zwae057. [PMID: 38332751 DOI: 10.1093/eurjpc/zwae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Patients with cancer are at increased cardiovascular risk. We aimed to compare the recommended and observed statin use among individuals with and without cancer. METHODS Using three 2-year cycles from the National Health and Nutrition Examination Survey [NHANES] (2013-2018), we analyzed data from 17,050 USA adults. We compared the prevalence of class 1 statin recommendations and use between individuals with and without cancer, overall and among different demographic groups. RESULTS Individuals with a history of cancer were older and had a higher burden of co-morbidities. Stratified by age groups, they were more likely to have a secondary prevention indication compared to individuals without cancer, but not a primary prevention indication for statin. Among individuals with an indication for statin therapy, the prevalence of statin use was higher in the cancer group compared to those without cancer (60.8% vs 47.8%, p < 0.001), regardless of sex, type of indication (primary vs secondary prevention), and education level. However, the higher prevalence of statin use in the cancer group was noted among younger individuals, ethnic minorities, and those with lower family income. CONCLUSION Our finding highlights the importance of optimization of cardiovascular health in patients with cancer, as Individuals with cancer were more likely to have a class 1 indication for statin treatment when compared to individuals without cancer. Important differences in statin use among cohorts based on sex, age, ethnicity, and SES were identified, which may provide a framework through which cardiovascular risk factor control can be targeted in this population.
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Affiliation(s)
- Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel. Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel. Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Martha Gulati
- Department of Cardiology, Barbra Striesand Women's Heart Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
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25
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Weight N, Moledina S, Kontopantelis E, Van Spall H, Dafaalla M, Chieffo A, Iannaccone M, Chen D, Rashid M, Mauri-Ferre J, Tamis-Holland JE, Mamas MA. Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study. Eur Heart J Qual Care Clin Outcomes 2024:qcae011. [PMID: 38323383 DOI: 10.1093/ehjqcco/qcae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Contemporary studies demonstrate that non-ST-segment elevation myocardial infarction (NSTEMI) processes of care vary according to sex. Little is known regarding variation in practice between geographical areas and centers. METHODS We identified 305 014 NSTEMI admissions in the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP), 2010-2017, including female sex (110 209). Hierarchical, multivariate logistic regression models were fitted assessing for differences in primary outcomes according to sex. Risk standardized mortality rates (RSMR) were calculated for individual hospitals to illustrate correlation with variables of interest. 'Heat-maps' were plotted to show regional and sex-based variation in opportunity-based quality-indicator score (surrogate for optimal processes of care). RESULTS Women presented older (77y vs. 69y, P < 0.001) and were more often Caucasian (93% vs. 91%, P < 0.001). Women were less frequently managed with an invasive coronary angiogram (ICA) (58% vs. 75%, P < 0.001) or percutaneous coronary intervention (PCI) (35% vs. 49%, P < 0.001)). In our hospital-clustered analysis, we show positive correlation between the RSMR and increasing proportion of women treated for NSTEMI (R2 = 0.17, P < 0.001). There was clear negative correlation between proportion of women who had an optimum OBQI score during their admission and RSMR (R2 = 0.22, P < 0.001), with weaker correlation in men (R2 = 0.08, P < 0.001). Heat-maps according to clinical commissioning group (CCG) demonstrate significant regional variation in OBQI score, with women receiving poorer quality care throughout the UK. CONLUSION There was a significant in variation of the management of patients with NSTEMI according to sex, with widespread geographical variation. Structural changes are required to enable improved care for women.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | | | - Harriette Van Spall
- Department of Medicine, McMaster University, Hamilton, Ontario; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario; Population Health Research Institute, Hamilton, Ontario
| | - Mohammed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Denis Chen
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Josepa Mauri-Ferre
- Departament de Salut, Gobierno de Cataluña, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
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Savage MP, Fischman DL, Mamas MA. Between a Rock and a Hard Place: Technological Progress in Treating Calcified Coronary Lesions. JACC Cardiovasc Interv 2024:S1936-8798(24)00015-3. [PMID: 38385927 DOI: 10.1016/j.jcin.2023.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Michael P Savage
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| | - David L Fischman
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mamas A Mamas
- Keele University, Stoke-on-Trent, Staffordshire, United Kingdom
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27
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Minhas AMK, Kobo O, Mamas MA, Al-Kindi SG, Abushamat LA, Nambi V, Michos ED, Ballantyne C, Abramov D. Social Vulnerability and Cardiovascular-Related Mortality Among Older Adults in the United States. Am J Med 2024; 137:122-127.e1. [PMID: 37879590 DOI: 10.1016/j.amjmed.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE The association of social vulnerability and cardiovascular disease-related mortality in older adults has not been well characterized. METHODS The Centers for Disease Control and Prevention database was evaluated to examine the relationship between county-level Social Vulnerability Index (SVI) and age-adjusted cardiovascular disease-related mortality rates (AAMRs) in adults aged 65 and above in the United States between 2016 and 2020. RESULTS A total of 3139 counties in the United States were analyzed. Cardiovascular disease-related AAMRs increased in a stepwise manner from first (least vulnerable) to fourth SVI quartiles; (AAMR of 2423, 95% CI [confidence interval] 2417-2428; 2433, 95% CI 2429-2437; 2516, 95% CI 2513-2520; 2660, 95% CI 2657-2664). Similar trends among AAMRs were noted based on sex, all race and ethnicity categories, and among urban and rural regions. Higher AAMR ratios between the highest and lowest SVI quartiles, implying greater relative associations of SVI on mortality rates, were seen among Hispanic individuals (1.52, 95% CI 1.49-1.55), Non-Hispanic-Asian and Pacific Islander individuals (1.32, 95% CI 1.29-1.52), Non-Hispanic- American Indian or Alaskan Native individuals (1.43, 95% CI 1.37-1.50), and rural counties (1.21, 95% CI 1.20-1.21). CONCLUSION Social vulnerability as measures by the SVI was associated with cardiovascular disease-related mortality in older adults, with the association being particularly prominent in ethnic minority patients and rural counties.
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Affiliation(s)
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio
| | - Layla A Abushamat
- Department of Medicine, Baylor College of Medicine, Houston, Tex; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Tex
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Tex; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Tex
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christie Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, Tex; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Tex
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Calif.
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Dafaalla M, Abramov D, Van Spall HG, Ghosh AK, Gale CP, Zaman S, Rashid M, Mamas MA. Heart Failure Readmission in Patients With ST-Segment Elevation Myocardial Infarction and Active Cancer. JACC CardioOncol 2024; 6:117-129. [PMID: 38510288 PMCID: PMC10950442 DOI: 10.1016/j.jaccao.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 03/22/2024] Open
Abstract
Background Although numerous studies have examined readmission with heart failure (HF) after acute myocardial infarction (AMI), limited data are available on HF readmission in cancer patients post-AMI. Objectives This study aimed to assess the rates and factors associated with HF readmission in cancer patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods A nationally linked cohort of STEMI patients between January 2005 and March 2019 were obtained from the UK Myocardial Infarction National Audit Project registry and the UK national Hospital Episode Statistics Admitted Patient Care registry. Multivariable Fine-Gray competing risk models were used to evaluate HF readmission at 30 days and 1 year. Results A total of 326,551 STEMI indexed admissions were included, with 7,090 (2.2%) patients having active cancer. The cancer group was less likely to be admitted under the care of a cardiologist (74.5% vs 81.9%) and had lower rates of invasive coronary angiography (62.2% vs 72.7%; P < 0.001) and percutaneous coronary intervention (58.4% vs. 69.5%). There was a significant prescription gap in the administration of post-AMI medications upon discharge such as an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (49.5% vs 71.1%) and beta-blockers (58.4% vs 68.0%) in cancer patients. The cancer group had a higher rate of HF readmission at 30 days (3.2% vs 2.3%) and 1 year (9.4% vs 7.3%). However, after adjustment, cancer was not independently associated with HF readmission at 30 days (subdistribution HR: 1.05; 95% CI: 0.86-1.28) or 1 year (subdistribution HR: 1.03; 95% CI: 0.92-1.16). The opportunity-based quality indicator was associated with higher rates of HF readmission independent of cancer diagnosis. Conclusions Cancer patients receive care that differs in important ways from patients without cancer. Greater implementation of evidence-based care may reduce HF readmissions, including in cancer patients.
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Affiliation(s)
- Mohamed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Dmitry Abramov
- Loma Linda University International Heart Institute, Loma Linda, California, USA
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arjun K. Ghosh
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, London, United Kingdom
- Hatter Cardiovascular Institute, University College London Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Yong JH, Mai AS, Matetić A, Elbadawi A, Elgendy IY, Lopez-Fernandez T, Mamas MA. Cardiovascular Risk in Patients with Hematological Malignancies: A Systematic Review and Meta-Analysis. Am J Cardiol 2024; 212:80-102. [PMID: 38042266 DOI: 10.1016/j.amjcard.2023.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 12/04/2023]
Abstract
Patients with hematologic malignancies (HMs) are at risk of future cardiovascular (CV) events. We therefore conducted a systematic review and meta-analysis to quantify their risk of future CV events. We searched Medline and EMBASE databases from inception until January 31, 2023 for relevant articles using a combination of keywords and medical subject headings. Studies examining CV outcomes in patients with HM versus controls without HM were included. The outcomes of interest included acute myocardial infarction (AMI), heart failure (HF), and stroke. The outcomes were expressed as hazard ratios (HRs) and their 95% confidence intervals (CIs). This study is registered with PROSPERO at CRD42022307814. A total of 15 studies involving 1,960,144 cases (178,602 patients with HM and 1,781,212 controls) were included in the quantitative analysis. A total of 10 studies examined the risk of AMI, 5 examined HF, and 11 examined stroke. Compared with the control group, the HRs for HM for AMI, HF, and stroke were 1.65 (95% CI 1.29 to 2.09, p <0.001), 4.82 (95% CI 3.72 to 6.25, p <0.001), and 1.60 (95% CI 1.30 to 1.97, p <0.001), respectively. The sensitivity analysis of stroke risk based on lymphoma type showed an increased risk of stroke in patients with non-Hodgkin lymphoma compared with controls (HR 1.31, 95% CI 1.04 to 1.64, p = 0.03) but no significant difference for Hodgkin lymphoma (HR 1.67, 95% CI 0.86 to 3.23, p = 0.08). Patients with HM are at increased risk of future AMI, HF, and stroke, and these findings suggest that CV care of patients with HM should be considered as a growing priority.
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Affiliation(s)
- Jung Hahn Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrija Matetić
- Department of Cardiology, University Hospital of Split, Split, Croatia; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Teresa Lopez-Fernandez
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom.
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Doolub G, Mamas MA, Dziewierz A, Malinowski KP, Oleś I, Kuleta M, Zdzierak B, Siudak Z. Do two operators improve outcomes in left main percutaneous coronary intervention? Insights from the ORPKI Registry. Minerva Cardiol Angiol 2024; 72:79-86. [PMID: 37870423 DOI: 10.23736/s2724-5683.23.06364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant left main coronary artery (LMCA) disease is prevalent in 7% of patients undergoing angiography. Limited data exists on the impact of double scrubbing in LMCA PCI. We sought to assess periprocedural outcomes in two-operator LMCA percutaneous coronary intervention (PCI). METHODS Using data from the Polish National Registry of PCI (ORPKI), we collected data on 28,745 patients undergoing LMCA PCI from 154 centers. Patients were divided into two groups based on the number of operators performing PCI (one vs. two operators). RESULTS LMCA PCI was performed by a single operator in 86% of the cases and by two operators in 14% of cases. Patients treated by two operators had a greater comorbidity burden including diabetes mellitus, arterial hypertension, previous myocardial infarction, and previous revascularization. In addition, these were more likely to be treated in high-volume centers, by operators with higher volume of LMCA PCIs. The risk of periprocedural death (2.37% vs. 2.44%; P=0.78), as well as cardiac arrest, coronary artery perforation, no-reflow, and puncture site bleeding was comparable between the two groups. On multivariable analysis, we found that a two-operator strategy was an independent predictor of periprocedural death, with this effect being much more profound in an elective setting (OR=5.13 [1.37-19.26]; P=0.015), compared to an urgent (ACS) setting (OR=1.32 [1.00-1.73]; P=0.047). CONCLUSIONS Our study suggests that a two-operator approach is not necessarily routinely recommended for LMCA interventions, although it can be considered for more complex cases.
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Affiliation(s)
- Gemina Doolub
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
- Unit of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Mamas A Mamas
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Artur Dziewierz
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital of Krakow, Krakow, Poland
| | - Krzysztof P Malinowski
- Jagiellonian University Medical College, Department of Bioinformatics and Telemedicine, Krakow, Poland
- Jagiellonian University Medical College, Digital Medicine and Robotics Center, Krakow, Poland
| | - Izabela Oleś
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Martyna Kuleta
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Barbara Zdzierak
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland -
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Burgess SN, Mamas MA. The invasive investigation of INOCA in the coronary catheterization lab. Am Heart J Plus 2024; 38:100365. [PMID: 38510741 PMCID: PMC10945914 DOI: 10.1016/j.ahjo.2024.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/17/2024] [Indexed: 03/22/2024]
Abstract
Over half of all patients with angina have no angiographically demonstratable obstructive coronary disease, with a significant proportion of these patients having undiagnosed microvascular dysfunction and/or vasospastic angina. In chronic coronary syndrome, ischemia with non-obstructive coronary artery disease (INOCA) often remains undiagnosed, or uninvestigated. INOCAmay occur due to vasospastic angina and microvascular dysfunction and require invasive assessment in the coronary catheterization lab. To evaluate INOCA coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) are used to assess microvascular dysfunction before acetylcholine provocation testing for coronary spasm. This review provides an overview of the invasive investigation of INOCA in the coronary catheterization lab for patients with angina to be optimally managed.
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Affiliation(s)
- Sonya N. Burgess
- Department of Cardiology, Nepean Hospital, Sydney, Australia
- University of Sydney, NSW, Australia
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
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Pana TA, Mamas MA, Wareham NJ, Khaw KT, Dawson DK, Myint PK. Sex-specific lifetime risk of cardiovascular events: the European Prospective Investigation into Cancer-Norfolk prospective population cohort study. Eur J Prev Cardiol 2024; 31:230-241. [PMID: 38031203 PMCID: PMC10809170 DOI: 10.1093/eurjpc/zwad283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 12/01/2023]
Abstract
AIMS Better understanding of sex differences in cardiovascular disease (CVD) is essential in tailoring appropriate preventative strategies. Using a large population-based study with follow-up >25 years, we aimed to determine sex-specific lifetime risks of incident CVD and cardiovascular (CV) mortality amongst populations with and without prevalent CVD. METHODS AND RESULTS Participants were drawn from the European Prospective Investigation into Cancer-Norfolk and followed up for a median of 26.2 years. Sex-specific lifetime risks were ascertained accounting for the competing risk of death. Models were adjusted for ethnicity and time-updated covariates: material deprivation, CV risk factors, lifestyle factors, comorbidities, and medication. A total of 23 859 participants [54.5% women; mean age (standard deviation) 59.2 (9.3) years at baseline] were included. Adjusted lifetime risks of incident CVD were higher in men than in women (69.1 vs. 57.7% at age 75): cause-specific hazard ratio (cHR) (99% confidence interval)-1.49 (1.41-1.57), while the risks of CV mortality at age 75 were 4.4% (men) and 3.1% (women): cHR-1.42 (1.31-1.54). Myocardial infarction was the predominant first presentation in men until the eighth decade. In women, the first CVD manifestations after their sixth decade were predominantly atrial fibrillation and stroke. The male-associated excess relative risks of incident CVD and CV mortality were halved in people with prevalent CVD. CONCLUSION We characterized the sex-specific lifetime CV risks in a large cohort. Men had substantially higher risk of incident CVD and CV mortality than women, which was attenuated amongst people with prevalent CVD. Our findings provide an evidence base for sex-specific CV prevention.
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Affiliation(s)
- Tiberiu A Pana
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Room 1:031, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | | | - Kay-Tee Khaw
- Gonville and Caius College, University of Cambridge, Cambridge, UK
| | - Dana K Dawson
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Room 1:031, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Phyo K Myint
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Room 1:031, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
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Ali N, Aktaa S, Younsi T, Beska B, Batra G, Blackman DJ, James S, Ludman P, Mamas MA, Abdel-Wahab M, Borregaard B, Iung B, Joner M, Kunadian V, Modine T, Neylon A, Petronio AS, Pibarot P, Popescu BA, Sabaté M, Stortecky S, Teles RC, Treede H, Gale CP. European Society of Cardiology Quality indicators for the care and outcomes of adults undergoing transcatheter aortic valve implantation. Eur Heart J Qual Care Clin Outcomes 2024:qcae006. [PMID: 38262740 DOI: 10.1093/ehjqcco/qcae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND AND AIMS To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults undergoing transcatheter aortic valve intervention (TAVI). METHODS We followed the European Society of Cardiology (ESC) methodology for the development of QIs. Key domains were identified by constructing a conceptual framework for the delivery of TAVI care. A list of candidate QIs were developed by conducting a systematic review of the literature. A modified Delphi method was then used to select the final set of QIs. Finally, we mapped the QIs to the EuroHeart Data Standards for TAVI to ascertain the extent to which the EuroHeart TAVI registry captures information to calculate the QIs. RESULTS We formed an international group of experts in quality improvement and TAVI, including representatives from the European Association of Percutaneous Cardiovascular Interventions, the European Association of Cardiovascular Imaging and the Association of Cardiovascular Nursing & Allied Professions. In total, 27 QIs were selected across eight domains of TAVI care, comprising 22 main (81%) and five secondary (19%) QIs. Of these, 19/27 (70%) are now being utilised in the EuroHeart TAVI registry. CONCLUSION We present the 2023 ESC QIs for TAVI, developed using a standard methodology and in collaboration with ESC Associations. The EuroHeart TAVI registry allows calculation of the majority of the QIs, which may be used for benchmarking care and quality improvement initiatives.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suleman Aktaa
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Tanina Younsi
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ben Beska
- Translational and Clinical Research Institute, Newcastle University Newcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle, UK
| | - Gorav Batra
- Department of medical sciences and Uppsala Clinical research center Uppsala University, Uppsala Sweden
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stefan James
- Department of medical sciences and Uppsala Clinical research center Uppsala University, Uppsala Sweden
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | | | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark. Department of Clinical Research, University of Southern Denmark, Denmark
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, and Université Paris-Cité, INSERM 1148, Paris, France
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle, UK
| | - Thomas Modine
- Hopital Cardiologique de Haut Leveque, Bordeaux, France
| | - Antoinette Neylon
- Galway University Hospital, SAOLTA Health Care Group, and National University of Ireland, Galway, Ireland
| | - Anna S Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa 2-56100, Italy
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Manel Sabaté
- Interventional Cardiology Department; Cardiovascular Institute; Hospital Clínic; IDIBAPS; Barcelona; Spain
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rui C Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Medical Center Mainz, Mainz, Germany
| | - Chris P Gale
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Abusnina W, Elhouderi E, Walters RW, Al-Abdouh A, Mostafa MR, Liu JL, Mazozy R, Mhanna M, Ben-Dor I, Dufani J, Kabach A, Michos ED, Aboeata A, Mamas MA. Sex Differences in the Clinical Outcomes of Patients With Takotsubo Stress Cardiomyopathy: A Meta-Analysis of Observational Studies. Am J Cardiol 2024; 211:316-325. [PMID: 37923154 DOI: 10.1016/j.amjcard.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared with females. Gender-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether gender-based differences are observed in TSCM clinical outcomes. A comprehensive literature search of PubMed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between male and female patients with TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I2 index. Twelve observational studies involving 51,213 patients (4,869 males and 46,344 females) were included in the meta-analysis. Male gender was associated with statistically significant higher in-hospital all-cause mortality compared with females in patients with TSCM (RR 2.17, 95% CI 1.77 to 2.67, p <0.001). The rate of cardiogenic shock was significantly higher in males with TSCM compared with females (RR 1.66, 95% CI 1.29 to 2.12, p <0.001). Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Male gender was associated with a two-fold greater in-hospital all-cause mortality risk compared with female gender. The higher mortality risk associated with male gender deserves further study, particularly whether it represents later recognition of the condition and disparities in treatments.
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Affiliation(s)
- Waiel Abusnina
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA; Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC.
| | - Eiman Elhouderi
- Department of Medicine, Beaumont Hospital, Dearborn, MI, USA
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mostafa R Mostafa
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, New York, USA
| | - John L Liu
- Creighton University School of Medicine, Omaha, NE, USA
| | - Ruqayah Mazozy
- Department of Cardiology, Zliten Medical Center, Zliten, Libya
| | - Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, IA, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC
| | - Jalal Dufani
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Amjad Kabach
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahemd Aboeata
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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Ranganathan S, Abramov D, Chew NWS, Mallen C, Marshall M, Kobo O, Mamas MA. Trends in Cardiovascular Mortality Among Patients With Alzheimer's Disease in the United States from 1999 to 2020. Am J Cardiol 2024; 211:326-333. [PMID: 37993040 DOI: 10.1016/j.amjcard.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
This study aimed to compare the trends in cardiovascular diseases (CVDs)-related mortality in patients with Alzheimer's disease (AD) and in the general population aged ≥65 years. Data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death dataset were used to determine national trends in age-adjusted CVD mortality rates (AAMR) and average annual percent change (AAPC) values in patients with AD and the overall population aged ≥65 years from 1999 to 2020. Data for AAMR and AAPCs were also stratified by age, gender, ethnicity/race, geographical region, urbanization status, and subgroups of CVD. Trends in the overall AAMR stratified by gender, age, ethnicity/race, geographical region, urbanization status, and CVD subgroups were statistically different between patients with AD and the overall population (overall AAPC for CVD mortality rate in patients with AD = -3.5% [confidence interval -4.1% to -2.9%] vs -2.6% [confidence interval -2.3% to -2.9%] in overall population, p = 0.01). Differences in the decrease in the mortality rates between patients with AD and the overall population were found to be statistically different across all stratifications except for the change in the mortality rates for hypertensive diseases (p = 0.05), females (p = 0.2), and Asian or Pacific Islanders (p = 0.09). In conclusion, CVD-related mortality in patients with AD decreased over the last 2 decades, and decreases were more prominent than seen in the general population aged ≥65 years. These results may help focus public health efforts to optimize CVD health in patients with AD.
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Affiliation(s)
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Christian Mallen
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Michelle Marshall
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Kobo
- School of Medicine, Keele University, Staffordshire, United Kingdom; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom.
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Lunardi M, Mamas MA, Mauri J, Molina CM, Rodriguez-Leor O, Eggington S, Pietzsch JB, Papo NL, Walleser-Autiero S, Baumbach A, Maisano F, Ribichini FL, Mylotte D, Barbato E, Piek JJ, Wijns W, Naber CK. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. Eur Heart J Qual Care Clin Outcomes 2024; 10:25-35. [PMID: 37286294 DOI: 10.1093/ehjqcco/qcad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/13/2023] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
AIMS As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications.This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. METHODS AND RESULTS Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group.STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49 332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (-1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. CONCLUSION The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.
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Affiliation(s)
- Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
- Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Mamas A Mamas
- Keele Cardiovascular Research, Keele University, Stoke on Trent, UK
| | - Josepa Mauri
- Gerència de Processos Integrats de Salut. Àrea Assistencial. Servei Català de la Salut. Generalitat de Catalunya, Barcelona, Spain
- Institut del Cor, Hospital Universiari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Medina Molina
- Registry of Myocardial Infarction, Catalan Health Service, Catalunyia, Barcelona, Spain
| | | | - Simon Eggington
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Natalie L Papo
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Silke Walleser-Autiero
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Francesco Maisano
- Valve Center OSR, Cardiac Surgery IRCCS San Raffaele Hospital, Vita Salute University UniSR, Milano, Italy
| | | | - Darren Mylotte
- Galway University Hospital, SAOLTA Healthcare Group and University of Galway, Galway, Ireland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, Roma, Italy
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
| | - Christoph K Naber
- Department of Internal Medicine I, Cardiology and Intensive Care, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
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Shamkhani W, Rashid M, Moledina S, Ludman P, Curzen N, Wijeysundera HC, Grines CL, Mamas MA. Complex High-Risk Percutaneous Coronary Intervention Types, Trends, and Outcomes in Nonsurgical Centres. Can J Cardiol 2024:S0828-282X(24)00010-2. [PMID: 38215968 DOI: 10.1016/j.cjca.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Limited data are available on complex high-risk percutaneous coronary intervention (CHiP) trends and outcomes in nonsurgical centres (NSCs), particularly in health care systems where most centres are NSCs. METHODS Using data from a national registry, we studied the characteristics and outcomes of CHiP procedures performed for stable angina from 2006 to 2017 according to the presence or absence of on-site surgical cover. Multivariate regression analyses and propensity score matching were used to determine risks for in-hospital death, major bleeding, and major cardiovascular or cerebral events (MACCE). RESULTS Out of 134,730 CHiP procedures, 42,433 (31.5%) were performed in NSCs, increasing from 12.5% in 2006 to 42% in 2017. Compared with surgical centres (SCs), patients who had a CHiP procedure undertaken in NSCs were, on average, 2.4 years older and had a greater prevalence of cardiovascular risks. Common CHiP procedures performed in NSCs included poor left ventricular function (41.6%), chronic renal failure (38.8%), and chronic total occlusion percutaneous coronary intervention (31.1%). NSC-based CHiP is associated with lower odds of mortality (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.5-0.8) and major bleeding (aOR 0.7, 95% CI 0.6-0.8). In both groups, MACCE odds were similar (aOR 1.0, 95% CI 0.9-1.1). CONCLUSIONS CHiP numbers have steadily increased in NSCs. NSC patients were older and had a higher prevalence of cardiovascular risks than SC patients. Mortality and major bleeding odds were significantly lower in those cases undertaken in NSCs, although MACCE odds were not different between the groups.
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Affiliation(s)
- Warkaa Shamkhani
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, United Kingdom
| | - Nick Curzen
- University of Southampton, Southampton, United Kingdom; Coronary Research Group, University Hospital Southampton, Southampton, United Kingdom
| | | | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Minhas AMK, Cullen MW, Mamas MA, Fudim M, Virani SS, Khan SS, Misra A, Ballantyne CM, Nambi V, Abramov D. Association Between Cardiologist Density and Mortality in Urban and Rural Counties in the United States. Am J Cardiol 2024; 210:279-282. [PMID: 37844717 DOI: 10.1016/j.amjcard.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Abdul Mannan Khan Minhas
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan; Baylor College of Medicine and Texas Heart Institute, Houston, Texas
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arunima Misra
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California.
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Zghebi SS, Kontopantelis E, Mamas MA. Cardiovascular Risk Prediction Tools in Patients With Diabetes-Are Not There Enough? What Is Still Missing? Am J Cardiol 2024; 210:306-308. [PMID: 37890568 DOI: 10.1016/j.amjcard.2023.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Salwa S Zghebi
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK; Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom.
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Sainbayar E, Pham HN, Beauti W, Shahid M, Hickerson N, Hassan K, Salih M, Ibrahim R, Mamas MA. Regional Disparities and Death Trends Related to Hemopericardial Cardiovascular Mortality. Am J Cardiol 2024; 210:8-10. [PMID: 37898157 DOI: 10.1016/j.amjcard.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023]
Affiliation(s)
| | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Wisam Beauti
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mahek Shahid
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Natalie Hickerson
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Kamal Hassan
- New York Presbyterian-Weill Cornell Medical Center, New York, New York
| | - Mohammed Salih
- Department of Cardiovascular Medicine, The Heart Hospital-Baylor University Medical Center, Plano, Texas
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona.
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom
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Gupta A, Shrivastava A, Chhikara S, Mamas MA, Vijayvergiya R, Swamy A, Mahesh NK, Singh N, Bajaj N, Singh B, Meena DS, Singh C. Optical Coherence Tomography Predictors of SIde Branch REstenosis after unprotected Left Main bifurcation angioplasty using double kissing crush technique (OP-SIBRE LM Study). Catheter Cardiovasc Interv 2024; 103:51-60. [PMID: 37994226 DOI: 10.1002/ccd.30915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Among the two stent strategies, contemporary evidence favors double kissing crush technique (DKC) for complex unprotected distal left main bifurcation (UdLMB) lesions. However one of the major challenges to these lesions is side branch (SB) restenosis. AIMS Our aim was to identify optical coherence tomographic (OCT) characteristics that may predict SB restenosis (SBR) after UdLMB angioplasty using DKC technique. METHODS This was a single-center, retrospective study that included 60 patients with complex UdLMB disease, who underwent OCT-guided angioplasty using DKC technique. Angiographic follow-up was performed in all patients at 1 year to identify patients with SBR. Patients with SBR group were compared with patients without SBR (NSBR group) for OCT parameters during index procedure. RESULTS Twelve (20%) patients developed SBR at 1-year follow-up. The SBR group had longer SB lesion (18.8 ± 3.2 vs. 15.3 ± 3.7 mm, p = 0.004) and neo-metallic carinal length (2.1 vs. 0.1 mm, p < 0.001) when compared to the NSBR group. Longer neo-metallic carinal length was associated with the absence of the dumbbell sign, presence of hanging stent struts across the SB ostium on OCT of final MB pullback. On multivariate regression analysis, SB distal reference diameter (DRD) and SB stent expansion were identified as independent predictors of SBR with SB-DRD of ≤2.8 mm (area under curve-0.73, sensitivity-83.3%, and specificity-62.5%) and SB stent expansion of ≤89% (area under curve-0.88, sensitivity-83.3%, and specificity- 81.2%) as the best cut off values to predict SBR. CONCLUSIONS SB DRD and SB stent expansion are the OCT predictors of future SBR after UdLMB angioplasty using DKC technique.
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Affiliation(s)
- Ankush Gupta
- Department of Cardiology, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | | | - Sanya Chhikara
- Department of Medicine, Jacobi Medical Center, Bronx, New York, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Center, PGIMER, Chandigarh, India
| | | | - Nalin K Mahesh
- St. Gregorios Medical Mission Hospital, Parumala, Kerala, India
| | - Navreet Singh
- Department of Cardiology, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Nitin Bajaj
- Department of Cardiology, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Balwinder Singh
- Department of Cardiology, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | | | - Chandraket Singh
- Department of Cardiology, Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
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Parmar SS, Mohamed MO, Mamas MA, Wilkie R. The clinical characteristics, managements, and outcomes of acute myocardial infarction in osteoarthritis patients; a cross-sectional analysis of 6.5 million patients. Expert Rev Cardiovasc Ther 2024; 22:121-129. [PMID: 38284347 DOI: 10.1080/14779072.2024.2311696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/25/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES The prevalence of osteoarthritis (OA) and cardiovascular disease are increasing and both conditions share similar risk factors. We investigated the association between OA and receipt of invasive managements and clinical outcomes in patients with acute myocardial infarction (AMI). METHODS Using the National Inpatient Sample, adjusted binary logistic regression determined the association between OA and each outcome variable. RESULTS Of 6,561,940 AMI hospitalizations, 6.3% had OA. OA patients were older and more likely to be female. OA was associated with a decreased odds of coronary angiography (adjusted odds ratio 0.91; 95% confidence interval 0.90, 0.92), PCI (0.87; 0.87, 0.88), and coronary artery bypass grafting (0.98; 0.97, 1.00). OA was associated with a decreased odds of adverse outcomes (in-hospital mortality: 0.68; 0.67, 0.69; major acute cardiovascular and cerebrovascular events: 0.71; 0.70, 0.72; all-cause bleeding: 0.76; 0.74, 0.77; and stroke/TIA: 0.84; 0.82, 0.87). CONCLUSIONS This study of a representative sample of the US population highlights that OA patients are less likely to be offered invasive interventions following AMI. OA was also associated with better outcomes post-AMI, possibly attributed to a misclassification bias where unwell patients with OA were less likely to receive an OA code because codes for serious illness took precedence.
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Affiliation(s)
- Simran Singh Parmar
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Keele University, Staffordshire, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Staffordshire, UK
| | - Ross Wilkie
- School of Medicine, Keele University, Staffordshire, UK
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Sainbayar E, Ibrahim R, Pham HN, Beauti W, Shahid M, Hickerson N, Salih M, Ferreira JP, Mamas MA. Social Vulnerability and Hemopericardial Cardiovascular Death: Insight from the Centers for Disease Control and Prevention Databases. Am J Cardiol 2024; 210:143-145. [PMID: 37844718 DOI: 10.1016/j.amjcard.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Affiliation(s)
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona.
| | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Wisam Beauti
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mahek Shahid
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Natalie Hickerson
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona
| | - Mohammed Salih
- Department of Cardiovascular Medicine, The Heart Hospital-Baylor University Medical Center, Plano, Texas
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom
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Matetic A, Mohamed MO, Essien UR, Guha A, Elkaryoni A, Elbadawi A, Van Spall HGC, Mamas MA. Association between cancer, CHA2DS2VASc risk, and in-hospital ischaemic stroke in patients hospitalized for atrial fibrillation. Eur Heart J Qual Care Clin Outcomes 2023; 9:749-757. [PMID: 36597791 DOI: 10.1093/ehjqcco/qcac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/24/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is commonly encountered in cancer patients. We investigated the CHA2DS2VASc score, and its association with in-hospital ischaemic stroke in patients with cancer who were hospitalized for AF. METHODS AND RESULTS Using the United States National Inpatient Sample, all hospitalizations with principal diagnosis of AF between October 2015 and December 2018 were stratified by cancer diagnosis, type, and CHA2DS2VASc risk categories (low risk, low-moderate risk, moderate-high risk). In-hospital ischaemic stroke and its association with the CHA2DS2VASc risk score was assessed across the groups using hierarchical multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Discrimination of CHA2DS2VASc score for in-hospital ischaemic stroke was evaluated with Receiver Operating Characteristic and Area Under the Curve (AUC). Among 1 341 870 included hospitalizations, 71 965 (5.4%) had comorbid cancer. Cancer patients had a higher proportion of moderate-high CHA2DS2VASc risk compared with their non-cancer counterparts (86.5% vs. 82.3%, P < 0.001). Compared with their low CHA2DS2VASc risk counterparts, cancer patients in low-moderate and moderate-high risk scores had similar odds of developing stroke (aOR 1.28 95% CI 0.22-7.63 and aOR 1.78 95% CI 0.41-7.66, respectively). The CHA2DS2VASc risk score had poor discrimination for ischaemic stroke in the cancer group (AUC 0.538 95% CI 0.477-0.598). CONCLUSION Cancer patients with AF have high CHA2DS2VASc risk. Discrimination of CHA2DS2VASc for ischaemic stroke is lower in cancer than non-cancer patients, and CHA2DS2VASc may not be adequate in determining ischaemic risk in cancer population.
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Affiliation(s)
- Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split 21000, Croatia
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, Stoke-on-Trent ST5 5BG, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, Stoke-on-Trent ST5 5BG, UK
| | - Utibe R Essien
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Ahmed Elkaryoni
- Department of Internal Medicine, Loyola Stritch School of Medicine, Maywood, IL 60153, USA
| | - Ayman Elbadawi
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Harriette G C Van Spall
- Division of Cardiology, McMaster University, Hamilton, ON L8S 4L8, Canada
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, Stoke-on-Trent ST5 5BG, UK
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Dafaalla M, Abdel-Qadir H, Gale CP, Sun L, López-Fernández T, Miller RJH, Wojakowski W, Nolan J, Rashid M, Mamas MA. Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study. Eur Heart J Qual Care Clin Outcomes 2023; 9:806-817. [PMID: 36921979 DOI: 10.1093/ehjqcco/qcad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 03/17/2023]
Abstract
AIMS To assess processes of care and clinical outcomes in cancer patients with ST elevation myocardial infarction (STEMI) according to cancer type. METHODS AND RESULTS This is a national population-based study of patients admitted with STEMI in the UK between January 2005 and March 2019. Data were obtained from the National Heart Attack Myocardial Infarction National Audit Project (MINAP) registry and the Hospital Episode Statistics registry. We identified 353 448 STEMI-indexed admissions between 2005 and 2019. Of those, 8581 (2.4%) had active cancer. Prostate cancer (29% of STEMI patients with cancer) was the most common cancer followed by haematologic malignancies (14%) and lung cancer (13%). Cancer patients were less likely to receive invasive coronary revascularization (60.0% vs. 71.6%, P < 0.001] and had higher in-hospital death [odd ratio (OR) 1.39, 95% confidence interval (CI) 1.25-1.54] and bleeding (OR 1.23, 95% CI 1.03-1.46). Cancer patients had higher mortality at 30 days (HR 2.39, 95% CI 2.19-2.62) and 1 year (HR 3.73, 95% CI 3.58-3.89). Lung cancer was the cancer associated with the highest risk of death in the hospital (OR 1.75, 95% CI 1.39-2.22) and at 1 year (OR 8.08, 95% CI 7.44-8.78). Colon cancer (OR 1.98, 95% CI 1.24-3.14) was the main cancer associated with major bleeding. All common cancer types were associated with higher mortality at 1 year. Cardiovascular death (62%) was the main cause of death in the first 30 days, while cancer (52%) was the main cause of death within 1 year. CONCLUSION STEMI patients with cancer have a higher risk of short- and long-term mortality, particularly lung cancer. Colon cancer is the main cancer associated with major bleeding. Cardiovascular disease was the main cause of death in the first month, whereas cancer was the main cause of death within 1 year.
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Affiliation(s)
- Mohamed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Husam Abdel-Qadir
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Louise Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Libin Cardiovascular Institute of Alberta and University of Calgary, Calgary, Alberta, Canada
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silezia, Katowice, Poland
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Galimzhanov A, Istanbuly S, Tun HN, Ozbay B, Alasnag M, Ky B, Lyon AR, Kayikcioglu M, Tenekecioglu E, Panagioti M, Kontopantelis E, Abdel-Qadir H, Mamas MA. Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:2018-2031. [PMID: 37499186 DOI: 10.1093/eurjpc/zwad243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
AIMS It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with Bc. METHODS AND RESULTS We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger's test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, Bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke. CONCLUSION Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied. REGISTRATION CRD42022298741.
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Affiliation(s)
- Akhmetzhan Galimzhanov
- Department of Propedeutics of Internal Disease, Semey Medical University, Semey, Kazakhstan
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
| | - Sedralmontaha Istanbuly
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Han Naung Tun
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Benay Ozbay
- Basaksehir Cam and Sakura State Hospital Department of Cardiology, Istanbul, Turkey
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Meral Kayikcioglu
- Department of Cardiology, Faculty of Medicine, 60521 Ege University, Izmir, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
- Department of Cardiology, Erasmus MC, Thorax Center, Erasmus University, Rotterdam, The Netherlands
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Husam Abdel-Qadir
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
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Weight N, Moledina S, Volgman AS, Bagur R, Wijeysundera HC, Sun LY, Chadi Alraies M, Rashid M, Kontopantelis E, Mamas MA. Socioeconomic disparities in the management and outcomes of acute myocardial infarction. Heart 2023; 110:122-131. [PMID: 37558395 DOI: 10.1136/heartjnl-2023-322601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Patients from lower socioeconomic status areas have poorer outcomes following acute myocardial infarction (AMI); however, how ethnicity modifies such socioeconomic disparities is unclear. METHODS Using the UK Myocardial Ischaemia National Audit Project (MINAP) registry, we divided 370 064 patients with AMI into quintiles based on Index of Multiple Deprivation (IMD) score, comprising seven domains including income, health, employment and education. We compared white and 'ethnic-minority' patients, comprising Black, Asian and mixed ethnicity patients (as recorded in MINAP); further analyses compared the constituents of the ethnic-minority group. Logistic regression models examined the role of the IMD, ethnicity and their interaction on the odds of in-hospital mortality. RESULTS More patients from the most deprived quintile (Q5) were from ethnic-minority backgrounds (Q5; 15% vs Q1; 4%). In-hospital mortality (OR 1.10, 95% CI 1.01 to 1.19, p=0.025) and major adverse cardiovascular event (MACE) (OR 1.07, 95% CI 1.00 to 1.15, p=0.048) were more likely in Q5, and MACE was more likely in ethnic-minority patients (OR 1.40, 95% CI 1.00 to 1.95, p=0.048) versus white (OR 1.05, 95% CI 0.98 to 1.13, p=0.027) in Q5. In subgroup analyses, Black patients had the highest in-hospital mortality within the most affluent quintile (Q1) (Black: 0.079, 95% CI 0.046 to 0.112, p<0.001; White: 0.062, 95% CI 0.059 to 0.066, p<0.001), but not in Q5 (Black: 0.065, 95% CI 0.054 to 0.077, p<0.001; White: 0.065, 95% CI 0.061 to 0.069, p<0.001). CONCLUSION Patients with a higher deprivation score were more often from an ethnic-minority background, more likely to suffer in-hospital mortality or MACE when compared with the most affluent quintile, and this relationship was stronger in ethnic minorities compared with White patients.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
| | | | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | - Louise Y Sun
- Division of Cardiac Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University Faculty of Medicine & Health Sciences, Keele, UK
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Sharp ASP, Kinnaird T, Curzen N, Ayyub R, Alfonso JE, Mamas MA, Bavière HV. Cost-effectiveness of intravascular ultrasound-guided percutaneous intervention in patients with acute coronary syndromes: A UK perspective. Eur Heart J Qual Care Clin Outcomes 2023:qcad073. [PMID: 38111201 DOI: 10.1093/ehjqcco/qcad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Use of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes over angiography alone. Despite this, the adoption of IVUS in clinical practice remains low. AIMS To examine the cost-effectiveness of IVUS-guided PCI compared to angiography alone in patients with acute coronary syndromes (ACS). METHODS A one-year decision tree and lifetime Markov model were constructed to compare the cost-effectiveness of IVUS-guided PCI to angiography alone for two hypothetical adult populations consisting of 1,000 individuals: ST-elevation myocardial infarction (STEMI) and unstable angina/ non-ST-elevation myocardial infarction (UA/NSTEMI) patients undergoing drug-eluting stent (DES) implantation. The UK healthcare system perspective was applied using 2019/20 costs. All-cause death, myocardial infarction (MI), repeat PCI, lifetime costs, life expectancy and quality-adjusted life-years (QALYs) were assessed. RESULTS Over a lifetime horizon, IVUS-guided PCI was cost-effective compared to angiography alone in both populations, yielding an incremental cost-effectiveness ratio of £3,649 and £5,706 per-patient in STEMI and UA/NSTEMI patients, respectively. In the one-year time horizon, the model suggested that IVUS was associated with reductions in mortality, MI and repeat PCI by 51%, 33% and 52% in STEMI and by 50%, 29% and 57% in UA/NSTEMI patients, respectively. Sensitivity analyses demonstrated the robustness of the model with IVUS being 100% cost-effective at a willingness-to-pay (WTP) threshold of £20,000 per QALY-gained. CONCLUSIONS From a UK healthcare perspective, an IVUS-guided PCI strategy was highly cost-effective over angiography alone amongst ACS patients undergoing DES implantation due to the medium- and long-term reduction in repeat PCI, death, and MI.
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Affiliation(s)
- Andrew S P Sharp
- University Hospital of Wales, Cardiff and Cardiff University, UK
| | - Tim Kinnaird
- University Hospital of Wales, Cardiff and Cardiff University, UK
| | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust and School of Medicine, University of Southampton, Southampton, UK
| | | | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Henri Vanden Bavière
- Philips, Chief Medical Office, Health Economic & Outcomes Research, Amsterdam, Netherlands
- Erasmus University College, Brussels, Belgium
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49
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Yogeswaran V, Hidano D, Diaz AE, Van Spall HGC, Mamas MA, Roth GA, Cheng RK. Regional variations in heart failure: a global perspective. Heart 2023; 110:11-18. [PMID: 37353316 DOI: 10.1136/heartjnl-2022-321295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Heart failure (HF) is a global public health concern that affects millions of people worldwide. While there have been significant therapeutic advancements in HF over the last few decades, there remain major disparities in risk factors, treatment patterns and outcomes across race, ethnicity, socioeconomic status, country and region. Recent research has provided insight into many of these disparities, but there remain large gaps in our understanding of worldwide variations in HF care. Although the majority of the global population resides across Asia, Africa and South America, these regions remain poorly represented in epidemiological studies and HF trials. Recent efforts and registries have provided insight into the clinical profiles and outcomes across HF patterns globally. The prevalence of HF and associated risk factors has been reported and varies by country and region ranges, with minimal data on regional variations in treatment patterns and long-term outcomes. It is critical to improve our understanding of the different factors that contribute to global disparities in HF care so we can build interventions that improve our general cardiovascular health and mitigate the social and economic cost of HF. In this narrative review, we hope to provide an overview of the global and regional variations in HF care and outcomes.
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Affiliation(s)
| | - Danelle Hidano
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andrea E Diaz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Newcastle, UK
| | - Gregory A Roth
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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50
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López-Fernández T, Farmakis D, Ameri P, Asteggiano R, de Azambuja E, Aznar M, Barac A, Bayes-Genis A, Bax JJ, Bergler-Klein J, Boriani G, Celutkiene J, Coats A, Cohen-Solal A, Córdoba R, Cosyns B, Filippatos G, Fox K, Gulati G, Inciardi RM, Lee G, Mamas MA, Novo G, Plummer C, Psyrri A, Rakisheva A, Suter T, Tini G, Tocchetti CG, Toutouzas K, Wilhelm M, Metra M, Lyon AR, Rosano GMC. European Society of Cardiology Core Curriculum for cardio-oncology. Eur J Heart Fail 2023. [PMID: 38059343 DOI: 10.1002/ejhf.3102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023] Open
Abstract
Cardio-oncology is a rapidly growing field of cardiovascular (CV) medicine that has resulted from the continuously increasing clinical demand for specialized CV evaluation, prevention and management of patients suffering or surviving from malignant diseases. Dealing with CV disease in patients with cancer requires special knowledge beyond that included in the general core curriculum for cardiology. Therefore, the European Society of Cardiology (ESC) has developed a special core curriculum for cardio-oncology, a consensus document that defines the level of experience and knowledge required for cardiologists in this particular field. It is structured into 8 chapters, including (i) principles of cancer biology and therapy; (ii) forms and definitions of cancer therapy-related cardiovascular toxicity (CTR-CVT); (iii) risk stratification, prevention and monitoring protocols for CTR-CVT; (iv) diagnosis and management of CV disease in patients with cancer; (v) long-term survivorship programmes and cardio-oncology rehabilitation; (vi) multidisciplinary team management of special populations; (vii) organization of cardio-oncology services; (viii) research in cardio-oncology. The core curriculum aims at promoting standardization and harmonization of training and evaluation in cardio-oncology, while it further provides the ground for an ESC certification programme designed to recognize the competencies of certified specialists.
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Affiliation(s)
- Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Riccardo Asteggiano
- Faculty of Medicine, Insubria University, Varese, Italy
- LARC (Laboratorio Analisi e Ricerca Clinica), Turin, Italy
| | - Evandro de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - Ana Barac
- Inova Schar Heart and Vascular and Inova Schar Cancer Institute, Falls Church, VA, USA
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Paris Cite University, INSERM U-942, Paris, France
| | - Raúl Córdoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute, Instituto de Investigación Sanitaria-Fundación Jiménez-Díaz (IIS-FJD), Madrid, Spain
| | - Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kevin Fox
- Imperial College Healthcare NHS Trust; NHS Orkney, Orkney, UK
| | - Geeta Gulati
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Riccardo M Inciardi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy
| | - Chris Plummer
- Department of Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, Attikon University Hospital, Athens, Greece
| | - Amina Rakisheva
- City Cardiolocal Center, Almaty, Kazakhstan
- Qonaev city hospital, Almaty, Kazakhstan
| | - Thomas Suter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giacomo Tini
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center for Clinical and Translational Research (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | | | - Matthias Wilhelm
- Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Metra
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, Guys and St. Thomas NHS Foundation Trust, London, UK
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