Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Health Fund Background. A novel comprehensive care program after acute myocardial infarction (AMI) „KOS-zawał" was implemented in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid telerehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of this program. The purpose of the pilot study was to evaluate a feasibility, safety and patients’ acceptance of HTR as component of a novel care program after AMI and to assess mortality in a one-year follow-up. Methods The study included 55 patients (LVEF 55.6 ± 6.8%; aged 57.5 ± 10.5 years). Patients underwent a 5-week HTR based on Nordic walking, consisting of an initial stage (1 week) conducted within an outpatient center and a basic stage (4-week) home-based telerehabilitation five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise training. The influence on physical capacity was assessed by comparing changes in functional capacity (METs) from the beginning and the end of HTR. Patients filled in a questionnaire in order to assess their acceptance of HTR at the end of telerehabilitation. Results HTR resulted in a significant improvement in functional capacity and workload duration in exercise test (Table). Safety: there were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the monitoring center. Prognosis all patients survived in a one-year follow-up. Conclusions Hybrid telerehabilitation is a feasible, safe form of rehabilitation, well accepted by patients. There were no deaths in a one-year follow-up. Outcomes before and after HTR Before telerehabilitation After telerehabilitation P Exercise time [s] 381.5 ± 92.0 513.7 ± 120.2 <0.001 Maximal workload [MET] 7.9 ± 1.8 10.1 ± 2.3 <0.001 Heart rate rest [bpm] 68.6 ± 12.0 66.6 ± 10.9 0.123 Heart rate max effort [bpm] 119.7 ± 15.9 131.0 ± 20.1 <0.001 SBP rest [mmHg] 115.6 ± 14.8 117.7 ± 13.8 0.295 DBP rest [mmHg] 74.3 ± 9.2 76.2 ± 7.3 0.079 SBP max effort [mm Hg] 159.5 ± 25.7 170.7 ± 25.5 0.003 DBP max effort [mm Hg] 84.5 ± 9.2 87.2 ± 9.3 0.043 SBP systolic blood pressure, DBP diastolic blood pressure.

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Components Analysis of Metabolic Syndrome in Acute Myocardial Infarction Patients

TAJ Journal of Teachers Association ◽

10.3329/taj.v29i2.39100 ◽

2018 ◽

Vol 29 (2) ◽

pp. 6-10

Author(s):

Khan MMR ◽

Sana NK ◽

PM Basak ◽

BC Sarker ◽

M Akhtarul Islam ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Acute Myocardial Infarction ◽

High Blood Pressure ◽

Abdominal Obesity ◽

Premature Death ◽

Medical College ◽

The Metabolic Syndrome ◽

Low Hdl

Background: Metabolic syndrome confers the risk of developing acute myocardial infarction which is the most common form of coronary heart disease and the single most important cause of premature death worldwide. The frequency and association of different components of metabolic syndrome on AMI are not well understood and has not been well evaluated.Objective: The aim of this study was to assess the components of the metabolic syndrome and its association with AMI patients. This study will help in awareness building in reducing AMI by early detection of components of metabolic syndrome.Patients and methods: This was a prospective observational study consisted of 325 AMI patients who were aged >20 years. Patients with first time AMI arriving in CCU of Rajshahi medical college during the period of 2012-2014, were included. Data were collected through interview, clinical examination, and laboratory tests within 24 hrs of AMI. Five components of metabolic syndrome were defined according to criteria set by modified NCEP ATP III (according to ethnic variation).Results: In AMI patients (n=325), no metabolic components were in 24 (7.4%) patients, one in 53 (16.3%), 2 components in 91(28.0%), 3 components were in 61(18.8%), 4 in 67(20.6%) and all 5 components were in 29 (8.9%) patients. In this study, there was no component in 7.4% of AMI patients, at least 1 component was 92.6%, at least 2 components were 76.3%, at least 3 components were 48.3%, at least 4 components were 29.5% and at least 5 components were 8.9%. The Metabolic syndrome was 48.3% (n=157). Among metabolic syndrome (≥3 components) in AMI (n=157, 48.3%) 4 components (20.6%) were more, next was 3 components (18.8%) and than 5 components (8.9%). Overall frequencies of components in acute myocardial infarction (n=325) were in order of abdominal obesity (54.8%) > high blood pressure (54.5%) > high FPG (54.2%) > Triglyceride (46.2%) and low HDL-C (46.2%) in acute myocardial infarction. Highest percentage was observed in abdominal obesity (54.8%) followed by high blood pressure (54.5%) and FPG (54.2%).TAJ 2016; 29(2): 6-10

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Characteristics of Acute Myocardial Infarction Patients

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v9i2.414 ◽

2020 ◽

Vol 9 (2) ◽

pp. 1017-1026

Author(s):

Desi Natalia Trijayanti Idris ◽

Dian Taviyanda ◽

Srinalesti Mahanani

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Family History ◽

Frequency Distribution ◽

Pulse Frequency ◽

Education History ◽

Male And Female ◽

History Of

Acute myocardial infarction (AMI) is a disease that has a high mortality. Usually happens to anyone and regardless of age, both male and female. The purpose of this study was to describe the characteristics of acute myocardial infarction patients hospitalized. This study uses a descriptive design. The variables used in this study were the characteristics of acute myocardial infarction patients consisting of gender, age, education, history of hypertension, history of diabetes mellitus, family history of acute myocardial infarction, blood pressure and pulse frequency. The number of samples used was 35 respondents who analyzed the data using a frequency distribution. The results showed that the characteristics of 35 respondents showed that the majority of AMI patients occurred in men, namely 60%, the majority were aged 56-60, namely 34.3%, the majority had a history of hypertension, diabetes mellitus and also a family history of having AMI.

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OP348 Assessing The Potential Value Of Wearable Digital Health Technologies In Chronic Kidney Disease Using Early Health Technology Assessment Methods

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321001033 ◽

2021 ◽

Vol 37 (S1) ◽

pp. 15-16

Author(s):

Vijay S. Gc ◽

Andrea Manca ◽

Alexander J. Casson ◽

Steven Antrobus ◽

Cynthia Iglesias

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Digital Health ◽

Qualitative Interviews ◽

Cost Effective ◽

Health Technology ◽

Self Management ◽

Health Technologies ◽

Early Health Technology Assessment ◽

Early Health

IntroductionWearable digital health technologies (WDHTs) offer several solutions in terms of disease monitoring, management and delivery of specific interventions. In chronic conditions, WDHTs can be used to support individuals’ self-management efforts, potentially improving adherence to (and outcomes resulting from) interventions. Early health technology assessment (HTA) methods can inform considerations about the potential clinical and economic benefits of technology in the initial phases of the product's lifecycle, facilitating identification of those Research & Development (R&D) investments with the greatest potential stakeholders’ payoff. We report our experience of using early HTA methods to support R&D decisions relating to novel WDHT being designed to support self-management of chronic kidney disease (CKD).MethodsWe performed a literature review, focus-group interviews with patients, and qualitative interviews with the prototype development team to understand the relevant characteristics of WDHTs, quantify relevant clinical indications and existing technological constraints. An early economic evaluation was used to identify the key drivers of value for money, and a discrete choice experiment shed light onto patient preferences towards what key features the WDHT should have for the users to adopt it. Then a model-based cost-effectiveness analysis was undertaken incorporating headroom analysis, return on investment, one-way sensitivity analysis and scenario analyses using data from secondary sources.ResultsThe review of the literature, focus groups with CKD patients, and qualitative interviews with technology developers helped to understand relevant characteristics of WDHT and user preferences helped inform the next R&D iteration. Compared to the standard care, WDHT that support stage ≥3 CKD patients self-management at home by measuring blood pressure and monitor mobility has the potential to be cost-effective at conventional cost-effectiveness threshold levels. From the headroom analysis, novel WDHT can be priced up to GBP280 (EUR315, USD360) and still be cost-effective compared to standard home blood pressure monitoring.ConclusionsOur study provides valuable information for the further development of the WDHT, such as defining a go/no-go decision, as well as providing a template for performing early HTA of Digital Health Interventions.

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BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF IN-HOSPITAL CARDIO-RENAL OUTCOMES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Journal of Hypertension ◽

10.1097/01.hjh.0000571196.29343.b6 ◽

2019 ◽

Vol 37 ◽

pp. e83

Author(s):

E. Mantzouranis ◽

C. Tsioufis ◽

K. Konstantinou ◽

A. Koumelli ◽

N. Vogiatzakis ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Blood Pressure Variability ◽

Renal Outcomes

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Association between admission systolic blood pressure and major adverse cardiovascular events in patients with acute myocardial infarction

PLoS ONE ◽

10.1371/journal.pone.0234935 ◽

2020 ◽

Vol 15 (6) ◽

pp. e0234935

Author(s):

Junyu Pei ◽

Xiaopu Wang ◽

Zhenhua Xing ◽

Pengfei Chen ◽

Wen Su ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Systolic Blood Pressure ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events

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Platelet-activating factor antagonism and streptokinase-induced hypotension in clinical acute myocardial infarction

Clinical Science ◽

10.1042/cs1000601 ◽

2001 ◽

Vol 100 (6) ◽

pp. 601-607 ◽

Cited By ~ 1

Author(s):

Roger TAYLOR ◽

Daniel FATOVICH ◽

Thomas HITCHCOCK ◽

Catherine MORRISON ◽

Lloyd CURTIS

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Receptor Antagonist ◽

Platelet Activating Factor ◽

Systolic Pressure ◽

Induced Hypotension ◽

Paf Receptor ◽

Double Blinded ◽

Paf Receptor Antagonist

Continuing efforts are being made to improve thrombolytic therapy for acute myocardial infarction (AMI). The rate of streptokinase (SK) infusion is commonly limited by the hypotension that is induced. If this could be avoided, an accelerated regimen of SK could be given, analagous to that used for other thrombolytic agents such as alteplase. The mechanism of the SK-induced hypotension is unknown, but there is some evidence that platelet-activating factor (PAF) plays a role. The potent PAF receptor antagonist lexipafant (10 mg) (n = 35), or matching placebo (n = 36), was administered intravenously over 5 min, in a randomized double-blinded protocol, to consecutive patients about to receive SK for AMI; all but three had inferior MI, because of the preference for strategies other than SK therapy in patients with anterior MI. The rate of infusion of SK was set to give 1.5×106 units over 30 min, anticipating significant hypotension. Blood pressure fell sharply over the first 10 min of SK administration. The maximum fall in systolic blood pressure occurred between 8 and 12 min, and averaged 43±28 mmHg (mean±S.D.) and 40±26 mmHg in patients given placebo and lexipafant respectively. Systolic pressure having fallen to < 90 mmHg, according to protocol the SK administration rate was reduced in 21 of 36 (58%) of patients given placebo and in 19 of 35 (54%) of patients given lexipafant. The total SK dose was given to all subjects over 40.3±17.5 and 40.2±13.4 min for the placebo and lexipafant groups respectively. Peak and time integrals of creatine kinase were not different in the two groups. There were no adverse effects attributable to lexipafant. It is concluded that the PAF receptor antagonist lexipafant has no significant effect on SK-induced hypotension and does not facilitate an accelerated regimen of administration.

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