scholarly journals Fibrinogen Predicts Mortality in High Risk Patients with Peripheral Artery Disease

2003 ◽  
Vol 26 (4) ◽  
pp. 381-386 ◽  
Author(s):  
L. Doweik ◽  
T. Maca ◽  
M. Schillinger ◽  
A. Budinsky ◽  
S. Sabeti ◽  
...  
Keyword(s):  
High Risk ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease

Abstract 266: Are Outpatient Cardiologists Asking about Peripheral Artery Disease Clinical Symptoms in Low and High Risk Patients in accordance with ACC/AHA Guidelines?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Ankitkumar K Patel ◽  
Rajesh M Kabadi ◽  
Rajani Sharma ◽  
Rita Schmidt ◽  
Elias Iliadis
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
High Risk ◽  
Peripheral Artery Disease ◽  
Clinical Symptoms ◽  
Low Risk ◽  
Peripheral Artery ◽  
Symptom Screening ◽  
Risk Patients ◽  
Artery Disease

Background: Lower extremity peripheral artery disease (PAD) is a common syndrome that afflicts many individuals and leads to significant morbidity. The American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Peripheral Artery Disease (PAD) (JACC, 2006) outlines four clinical symptoms (claudication, walking impairment, exertional leg complaints and poorly healing wounds) that should be asked to at risk patients. Outpatient cardiology practices often take care of individuals at risk for PAD and have the opportunity to screen and improve quality of medical care in accordance with professional guidelines. Methods: A group of 367 outpatients seen in a large academic cardiology practice from September 2011 underwent chart review. Risk factors for PAD that were assessed include history of smoking, hypertension, diabetes, hyperlipidemia, homocysteine levels, and CRP. Those that had three or more risk factors or a previous diagnosis of known PAD were classified as high risk and those with less than 2 risk factors were classified as low risk. Documentation of whether clinical symptoms were asked was obtained from outpatient chart. Fisher exact test was utilized for statistical analysis. Results: Fifty-seven percent (N=208) of our population were classified as high risk for PAD and forty-three percent (N=158) were low risk. Table 1 below shows assessment of clinical symptoms in high and low risk patients. Conclusions: Though both high risk and low risk PAD patients are assessed at equivalent rates for clinical symptoms, the vast majority of patients overall are underassessed. Lack of knowledge of clinical symptoms can lead to underscreening of PAD and thus undertreatment. Increasing clinical symptom screening in the outpatient cardiology setting can lead to quality improvement and adherence to ACC/AHA Guidelines.

scholarly journals Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery

2021 ◽  
Vol 23 (4) ◽  
pp. 485-491
Author(s):  
О. К. Gogayeva
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
High Risk ◽  
Normal Weight ◽  
High Risk Patients ◽  
Type 2 Dm ◽  
Risk Patients ◽  
Comorbidity Index ◽  
Artery Disease

The aim: to determine the comorbidity index before cardiac surgery in high-risk patients with coronary artery disease (CAD). Materials and methods. A retrospective analysis of data from 354 random high-risk patients who underwent a surgery and were discharged from National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during the period 2009–2019. The mean age of patients was 61.9 ± 9.6 years. All the patients were examined: ECG, ECHO CG, coronary angiography before the surgery as well as Charlson comorbidity index was calculated and a risk on the scales EuroSCORE I, EuroSCORE II and STS was stratified. Results. I–III degree obesity was revealed in 133 (37.5 %) patients, patients with type 2 diabetes mellitus (DM) were more likely to have BMI >30 kg/m2 (P = 0.017). Patients with normal weight had a carotid artery stenosis >50 % (P = 0.014) and history of stroke (P = 0.043) significantly more frequently. No differences in comorbidity of overweight and normal weight patients were detected (5.73 ± 1.70 vs. 5.9 ± 1.8, P = 0.4638). Type 2 DM was diagnosed in 90 (25.4 %) patients. In the case of normoglycemia, the comorbidity index was significantly lower than in type 2 DM (4.88 ± 1.38 vs. 6.60 ± 2.03, P = 0.0001) and glucose intolerance 5.8 ± 1.5 (P < 0.0001). Chronic kidney disease (CKD) G3a–G4 stages was diagnosed in 132 (37.2 %) patients. Significant higher comorbidity was found in patients with G3a–G4 stages CKD in comparison to those with G1–G2 stages CKD – 6.33 ± 1.78 vs. 5.46 ± 1.60 (P < 0.0001). Among comorbidities in patients with gouty arthritis, type 2 DM (P < 0.0001), obesity (P = 0.0080), CKD G3a–G4 (P = 0.0020) and varicose veins of the lower extremities (P = 0.0214) were significantly more common. Preoperative risk stratification according to the EuroSCORE II scale averaged 8.8 %. Conclusions. Preoperative analysis of baseline status in CAD patients showed the high Charlson comorbidity index, which averaged 5.7 ± 1.7. The weak direct correlation between the comorbidity index and the high predicted cardiac risk on the ES II scale (r = 0.2356, P = 0.00001), length of stay in the intensive care unit (r = 0.1182, P = 0.0262) and discharge after the surgery (r = 0.1134, P = 0.0330) was found.

scholarly journals Predictors of coronary artery disease progression among high-risk patients with recurrent symptoms

Heart Views ◽  
2018 ◽  
Vol 19 (2) ◽  
pp. 45
Author(s):  
MouazH Al-Mallah ◽  
Iyad Farah ◽  
AmjadM Ahmed ◽  
Raed Odeh ◽  
Eltayyeb Alameen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Disease Progression ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease ◽  
Coronary Artery Disease Progression

Angioplasty and stenting for carotid artery stenosis: indications, techniques, results, and complications

1998 ◽  
Vol 5 (6) ◽  
pp. E5 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Richard D. Fessler ◽  
Robert A. Mericle ◽  
Ajay K. Wakhloo ◽  
Lee R. Guterman ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
High Risk Patients ◽  
Clinical Series ◽  
Risk Patients ◽  
Artery Disease ◽  
Angioplasty And Stenting

Following the favorable results obtained in the treatment of coronary artery disease, combined angioplasty and stenting has been advocated for the treatment of carotid artery stenosis as well. Although widespread application of angioplasty and stenting for carotid artery disease is neither indicated nor recommended, it may be a viable alternative therapy for select patients who are high-risk patients for surgery. The results of early series have suggested that endoluminal revascularization in these high-risk patients can be performed with an acceptable degree of safety. Although the incidence of death and major stroke rates following angioplasty and stenting procedures compares favorably with surgery, results of more recent clinical series have suggested that the incidence of perioperative transient neurological events and minor strokes may be higher than suggested by earlier reports, especially in patients with recent neurological symptoms and “unstable” plaques. In this article, the authors review the current potential indications for and preliminary results of angioplasty and stenting and describe their procedural technique. In addition, potential applications of stenting to intracranial thromboocclusive carotid artery disease are reviewed.

Abstract P275: Demographic and Clinical Profile of Patients with Risk Factors for Coronary Heart Disease (CHD) Defined by National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Guidelines

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
David M Kern ◽  
Sanjeev Balu ◽  
Ozgur Tunceli ◽  
Swetha Raparla ◽  
Deborah Anzalone
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Groups ◽  
Lipid Lowering ◽  
High Risk Patients ◽  
Low Hdl ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High ◽  
Statin Use

Introduction: This study aimed to compare the demographic and clinical characteristics of patients with different risk factors for CHD as defined by NCEP ATP III guidelines. Methods: Dyslipidemia patients (≥1 medical claim for dyslipidemia, ≥1 pharmacy claim for a statin, or ≥1 LDL-C value ≥100 mg/dL [index date]) aged ≥18 y were identified from the HealthCore Integrated Research Environment from 1/1/2007-7/31/2012. Patients were classified as low risk (0 or 1 risk factor): hypertension, age ≥45 y [men] or ≥55 y [women], or low HDL-C), moderate/moderately high risk (≥2 risk factors), high risk (having CHD or CHD risk equivalent), or very high risk (having ACS or other established cardiovascular disease plus diabetes or metabolic syndrome). Demographics, comorbidities, medication use and lipid levels during the 12 months prior, and statin use during the 6 months post-index date were compared across risk groups (very high vs each other risk group). Results: There were 1,524,351 low-risk (mean age: 47 y; 45% men), 242,357 moderate-risk (mean age: 58 y; 59% men), 188,222 high-risk (mean age: 57 y; 52% men), and 57,469 very-high-risk (mean age: 63 y; 61% men) patients identified. Mean Deyo-Charlson comorbidity score differed greatly across risk strata: 0.20, 0.33, 1.26, and 2.22 from low to very high risk (p<.0001 for each). Compared with high-risk patients, very-high-risk patients had a higher rate of ischemic stroke: 5.4% vs 4.1%; peripheral artery disease: 17.1% vs 11.6%; coronary artery disease: 8.5% vs 8.2%; and abdominal aortic aneurysm: 2.3% vs 2.0% (p<.05 for each). Less than 1% of the total population had a prior prescription for each non-statin lipid-lowering medication (bile acid sequestrants, fibrates, ezetimibe, niacin, and omega-3). Very-high-risk patients had lower total cholesterol (very-high-risk mean: 194 mg/dL vs 207, 205, and 198 mg/dL for low-, moderate-/moderately-high-, and high-risk patients, respectively) and LDL-C (very-high-risk mean: 110 mg/dL vs 126, 126, and 116 mg/dL for the other risk groups; p<.0001 for each); higher triglycerides (TG) (very-high-risk mean: 206 mg/dL vs 123, 177, and 167 mg/dL for the other groups; p<.0001 for each); and lower HDL-C (very-high-risk mean: 45 mg/dL vs 57 [p<.0001], 45 [p=.006], and 51 mg/dL [p<.0001]). Statin use was low overall (15%), but higher in the very-high-risk group (45%) vs the high- (29%), moderate-/moderately-high- (18%), and low- (12%) risk groups (p<.0001 for each). Conclusions: Despite a large proportion of patients having high lipid levels, statin use after a dyslipidemia diagnosis was low: ≥80% of all patients (and more than half at very high risk) failed to receive a statin, indicating a potentially large population of patients who could benefit from statin treatment. Prior use of non-statin lipid-lowering medications was also low considering the high TG and low HDL-C levels among high-risk patients.

Abstract 91: Are At Risk Outpatient Cardiology Patients being Appropriately Evaluated for Lower Extremity PAD as Recommended by ACC/AHA Guidelines?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Rajesh M Kabadi ◽  
Ankitkumar Patel ◽  
Rajani Sharma ◽  
Rita Schmidt ◽  
Elias Iliadis
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
High Risk ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Heart Association ◽  
Low Risk ◽  
Peripheral Artery ◽  
Artery Disease

Background: Lower extremity peripheral artery disease (PAD) is a common syndrome that afflicts many individuals and leads to significant morbidity. Once appropriate at risk patients are identified, ankle-brachial index (ABI) testing is a relatively quick and inexpensive test that is recommended for proper assessment of PAD, per the recommendations outlined in the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Peripheral Artery Disease (PAD) (JACC, 2006). Outpatient cardiology practices often take care of individuals at risk for PAD and have the opportunity to test and appropriately treat this condition. Methods: A randomly selected group of 367 outpatients seen in a large academic cardiology practice from September 2011 underwent retrospective chart review. Risk factors for PAD that were assessed include history of smoking, hypertension, diabetes, hyperlipidemia, homocysteine levels, and CRP. Those that had three or more risk factors were classified as high risk and those with less than that were classified as low risk and frequency of ABI testing was evaluated. Fishers exact test was utilized for statistical analysis. Results: Fifty-one percent (N=187) of our population were classified as high risk for PAD, forty-three percent (N=158) were low risk, and six percent (N=22) were known to already have PAD. Amongst the high risk individuals, only six percent (N=12) had ABI testing performed while there were three percent (N=6) of low risk individuals that had this test (p=-0.34). Conclusions: There was no difference in ABI testing between high and low risk populations. Limitations of this study include lack of information regarding other diagnostic modalities that may have been used in place of ABI testing. Quality improvement may be achieved by increased use of such testing as this would allow for quicker identification of the disease, prompter treatment, and better outcomes, at a minimal cost.

Cardiovascular risk assessment in diabetes and pre-diabetes

ESC CardioMed ◽  
2018 ◽  
pp. 923-924
Author(s):  
Nikolaus Marx
Keyword(s):  
Risk Assessment ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Target Organ Damage ◽  
Risk Scores ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High

Patients with diabetes exhibit an increased propensity to develop cardiovascular disease with an increased mortality. Early risk assessment, especially for coronary artery disease, is important to initiate therapeutic strategies to reduce cardiovascular risk. This chapter reviews the current literature on risk scores in patients with type 1 and type 2 diabetes and summarizes the role of risk assessment based on biomarkers and different imaging strategies. Current guidelines recommend that patients with diabetes are characterized as high-risk or very high-risk patients. In the presence of target organ damage or other risk factors such as smoking, marked hypercholesterolaemia, or hypertension, patients with diabetes are classified as very high-risk patients while most other people with diabetes are categorized as high-risk patients.

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