1
|
Kim HY, Chang SA, Kim KH, Kim JY, Seo WK, Kim H, Seo JS, Shin SH, Rhee SJ, Lee SH, Cho JS. Epidemiology of Venous Thromboembolism and Treatment Pattern of Oral Anticoagulation in Korea, 2009-2016: a Nationwide Study Based on the National Health Insurance Service Database. J Cardiovasc Imaging 2021; 29:265-278. [PMID: 34080344 PMCID: PMC8318819 DOI: 10.4250/jcvi.2021.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/21/2021] [Revised: 03/02/2021] [Accepted: 03/19/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The annual incidence of venous thromboembolism (VTE) is increasing, and the treatment pattern of oral anticoagulants (OACs) has changed with introduction of new oral anticoagulants (NOACs). The aims of this study were to assess the annual incidence of VTE in a Korean population and the change of treatment pattern with availability of NOACs using a population-based database. METHODS Using the Korean National Health Insurance Services database, we identified patients diagnosed with VTE between 2009 and 2016. The annual prevalence of VTE and clinical characteristics and treatment pattern were investigated. The annual incidence of VTE was calculated using direct and indirect methods using the estimated Korean population in 2009 as the reference. RESULTS The annual incidence of VTE in Korean has increased yearly from 23.9 per 100,000 in 2009 to 42.2 in 2016. The overall rate of OAC prescription for VTE treatment increased from 55.9% to 68% in the same time period. The rate of initiation of NOAC treatment greatly increased, particularly from 2013 onwards, with a 20-fold increase from 2009 to 2016 (2.1% vs. 54.3%). CONCLUSIONS The annual incidence of VTE in Korea increased by almost two-fold from 2009 to 2016. The rate of initiation of NOAC treatment has increased substantially since 2013, and these agents have surpassed VKAs as the anticoagulant of choice for VTE. This temporal pattern of OAC prescription is consistent with the current clinical guidelines, which indicate NOACs over the warfarin in patients with VTE.
Collapse
Affiliation(s)
- Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung A Chang
- Department of Internal Medicine, Cardiovascular Imaging Center, Heart, Vascular & Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Jae Young Kim
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Keun Seo
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong Sook Seo
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sung Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Sang Jae Rhee
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Sun Hwa Lee
- Department of Cardiology in Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jung Sun Cho
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | |
Collapse
|
2
|
Jung JM, Kim YH, Yu S, O K, Kim CK, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Long-Term Outcomes of Real-World Korean Patients with Atrial-Fibrillation-Related Stroke and Severely Decreased Ejection Fraction. J Clin Neurol 2019; 15:545-554. [PMID: 31591844 PMCID: PMC6785482 DOI: 10.3988/jcn.2019.15.4.545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/16/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The clinical implications of echocardiography findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients are unknown. METHODS This was a substudy of the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent two-dimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the left-ventricle (LV) ejection fraction (LVEF), the left atrium diameter, and the ratio of the peak transmitral filling velocity to the mean mitral annular velocity during early diastole (E/e' ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). The E/e' ratio associated with the LV filling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. RESULTS This study finally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42-2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.58-9.69] and all-cause death (HR, 1.95; 95% CI, 1.23-3.10). The multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. CONCLUSIONS Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.
Collapse
Affiliation(s)
- Jin Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yong Hyun Kim
- Department of Cardiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi O
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, Mokdong Hospital, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jeong Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jong Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Joon Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Kang Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yang Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
3
|
Choi JY, Seo WK, Oh K, Seo SI, Ryou N, Chae SW. Vertebral Artery Compression during Roll Tilt: Is the Edge of the Foramen Magnum a Culprit? J Clin Neurol 2015; 11:292-4. [PMID: 26174788 PMCID: PMC4507388 DOI: 10.3988/jcn.2015.11.3.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jeong Yoon Choi
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Woo Keun Seo
- Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea.
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Sang Il Seo
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Namhyung Ryou
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Sung Won Chae
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
4
|
Seo WK, Kang J, Jeon M, Lee K, Lee S, Kim JH, Oh K, Koh SB. Feasibility of using a mobile application for the monitoring and management of stroke-associated risk factors. J Clin Neurol 2015; 11:142-8. [PMID: 25851892 PMCID: PMC4387479 DOI: 10.3988/jcn.2015.11.2.142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 05/08/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Recent advances in information technology have created opportunities for advances in the management of stroke. The objective of this study was to test the feasibility of using a smartphone software application (app) for the management of vascular risk factors in patients with stroke. Methods This prospective clinical trial developed a smartphone app, the 'Korea University Health Monitoring System for Stroke: KUHMS2,' for use by patients with stroke. During a 6-month follow-up period, its feasibility was assessed by measuring the changes in their vascular risk-factor profiles and the number of days per patient with data registration into the app. The effect of the app on the achievement rate of risk-factor targets was assessed by classifying subjects into compliant and noncompliant groups. Results At the end of the trial, data on 48 patients were analyzed. The number of days on which data were registered into the app was 60.42±50.17 (mean±standard deviation). Among predefined vascular risk factors, the target achievement rate for blood pressure and glycated hemoglobin (HbA1c) improved significantly from baseline to the final measurement. The serial changes in achievement rates for risk-factor targets did not differ between the compliant and noncompliant groups. Conclusions Many challenges must be overcome before mobile apps can be used for patients with stroke. Nevertheless, the app tested in this study induced a shift in the risk profiles in a favorable direction among the included stroke patients.
Collapse
Affiliation(s)
- Woo Keun Seo
- Department of Neurology, College of Medicine, Korea University, Guro Hospital, Seoul, Korea.
| | - Jaewoo Kang
- Department of Computer and Radio Communications Engineering, Korea University, Seoul, Korea
| | - Minji Jeon
- Department of Computer and Radio Communications Engineering, Korea University, Seoul, Korea
| | - Kyubum Lee
- Department of Computer and Radio Communications Engineering, Korea University, Seoul, Korea
| | - Sunwon Lee
- Department of Computer and Radio Communications Engineering, Korea University, Seoul, Korea
| | - Ji Hyun Kim
- Department of Neurology, College of Medicine, Korea University, Guro Hospital, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, College of Medicine, Korea University, Guro Hospital, Seoul, Korea
| | - Seong Beom Koh
- Department of Neurology, College of Medicine, Korea University, Guro Hospital, Seoul, Korea
| |
Collapse
|
5
|
Abstract
The objective of this study was to apply and test the effects of cognitive training on community-dwelling, elderly Koreans. The cognitive training was applied for 24 weeks to 129 elderly participants. The participants were divided into two groups to receive either cognitive training followed by observational period, or observational period followed by cognitive training. The primary outcome measures were the geriatric depression scale (Geriatric Depression Scale Short Form-Korean, GDS-SF-K) and mini-mental status examination (Mini-Mental State Examination in the Korean version, MMSE-KC) scores. There were no differences between the average GDS-SF-K and MMSE-KC scores of the two groups. However, the participants with cognitive dysfunction (defined as baseline MMSE below the 16th percentile according to age, sex and educational level) who received cognitive training initially had significantly improved MMSE-KC score on weeks 8 and 16, compared with the participants with cognitive dysfunction who were observed first. However, the participants who received cognitive training later did in fact catch up with the other group in terms of MMSE-KC score. Cognitive training by visiting nursing services was more effective in the elderly with cognitive dysfunction.
Collapse
Affiliation(s)
- M H Park
- Department of Neurology, Korea University College of Medicine, Ansan, Korea
| | | | | | | | | |
Collapse
|