scholarly journals A nationwide survey on participation in cardiac rehabilitation among patients with coronary heart disease using health claims data in Japan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shosuke Ohtera ◽  
Genta Kato ◽  
Hiroaki Ueshima ◽  
Yukiko Mori ◽  
Yuka Nakatani ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Nationwide Survey ◽  
Coronary Intervention ◽  
Health Claims ◽  
National Database ◽  
Nutritional Education ◽  
Health Claims Data

AbstractPoor implementation and variable quality of cardiac rehabilitation (CR) for coronary heart disease (CHD) have been a global concern. This nationwide study aimed to clarify the implementation of and participation in CR among CHD patients and associated factors in Japan. We conducted a retrospective cohort study using data extracted from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in 2017–2018 were included. Aspects of CR were assessed in terms of (1) participation in exercise-based CR, (2) pharmacological education, and (3) nutritional education. Of 87,829 eligible patients, 32% had participated in exercise-based CR, with a mean program length of 40 ± 71 days. CABG was associated with higher CR participation compared to PCI (OR 10.2, 95% CI 9.6–10.8). Patients living in the Kyushu region were more likely to participate in CR (OR 2.59, 95% CI 2.39–2.81). Among patients who participated in CR, 92% received pharmacological education, whereas only 67% received nutritional education. In Japan, the implementation of CR for CHD is insufficient and involved varying personal, therapeutic, and geographical factors. CR implementation needs to be promoted in the future.

scholarly journals Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

2019 ◽  
Vol 6 (4) ◽  
pp. 41
Author(s):  
Umme Rumana ◽  
Richard Kones ◽  
Montather O. Taheer ◽  
Mohamed Elsayed ◽  
Craig W. Johnson
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Artery Bypass ◽  
Secondary Analysis ◽  
Heart Association ◽  
Coronary Intervention ◽  
Significant Rise ◽  
Patient Choice ◽  
Diabetic Patients ◽  
Period 2

In diabetes patients with chronic ≥3 vessel disease, coronary artery bypass grafting (CABG) holds a class I recommendation in the American College of Cardiology and American Heart Association (ACC/AHA) 2011 guidelines, and this classification has not changed to date. Much of the literature has focused upon whether CABG or percutaneous coronary intervention (PCI) produces better outcomes; there is a paucity of data comparing the odds of receiving these procedures. A secondary analysis was conducted in a de-identified database comprised of 30,482 patients satisfying the entry criteria. Odds of occurrence (CABG, PCI) were determined as the binary dependent variable in period 1, (17 October 2009 through 31 December 2011), and period 2 (1 January 2013 through 16 March 2015), before and after the 2011 guidelines, while controlling for gender, ethnicity/race, and ischemic heart disease as covariates. The odds of performing CABG rather than PCI in period 2 were not statistically significantly different than in period 1 (p = 0.400). The logistic regression model chi-square statistic was statistically significant, with χ2 (7) = 308.850, p < 0.0001. The Wald statistic showed that ethnicity/race (African American, Caucasian, Hispanic and Other), gender, and heart disease contributed significantly to the prediction model with p < 0.05, but ethnicity ‘Unknown’ did not. The odds of CABG versus PCI in period 2 were 0.98 times those in period 1 95% confidence interval (CI) = (0.925, 1.032), statistically controlling for covariates. There was no significant rise in the odds of undergoing a CABG among this dataset of high-risk patients with diabetes and multivessel coronary heart disease. Modern practice has evolved regarding patient choice and additional variables that impact the final revascularization method employed. The degree to which odds of occurrence of procedures are a reliable surrogate for provider compliance with guidelines remains uncertain.

scholarly journals A predictive model for prediction of heart surgery procedure

2019 ◽  
Vol 15 (3) ◽  
pp. 1615
Author(s):  
Aufzalina Mohd Yusof ◽  
Nor Azura Md. Ghani ◽  
Khairul Asri Mohd Ghani ◽  
Khairul Izan Mohd Ghani
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Classification Rate ◽  
Potential Risk Factors ◽  
Drug Eluting ◽  
Model Treatment ◽  
Male Patients

Coronary heart disease (CHD) is a disease in which plague in the form of waxy substance builds up inside the coronary arteries. Coronary artery bypass grafting (CABG) is used as treatment on CHD patients but the role of CABG has been challenged by percutaneous coronary intervention (PCI) when it was introduced in 1977.  Drug eluting stents (DES) was introduced with the development of PCI. The purpose of this study was to find the potential risk factors that associated with the procedures (CABG and DES) and to model procedure (CABG vs DES) on coronary heart disease male patients aged 45 years old and below. The study sample was among male patients aged 45 years old and below who has undergone CABG or DES procedure at either IJN or HUKM  from January 2007 until December 2010. Logistic regression was used to model treatment selection on coronary heart disease with 87.3% of the classification rate. Patient who i) smoke, ii) obese, or ii) had dyslipidemia was significantly associated with DES, and the other factors were prone to have CABG as their treatment.

Abstract 3241: Long-TermSurvival after Coronary Artery Bypass versus Percutaneous Coronary Intervention with Bare Metal Stent Implantation in Patients with Diabetic Retinopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Takayuki Ohno ◽  
Yoshihiro Suematsu ◽  
Noboru Motomura ◽  
Minoru Ono ◽  
Hideo Fujita ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Overall Survival ◽  
Percutaneous Coronary Intervention ◽  
Diabetic Retinopathy ◽  
Heart Disease ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bare Metal ◽  
Percutaneous Coronary

Background : Coronary heart disease is the leading cause of death in diabetic population. Compared with diabetics without retinopathy, diabetics with retinopathy have an increased risk of myocardial infarction and death from coronary heart disease. Therefore, it is crucial to select an appropriate revascularization method in this considerable high-risk group. Methods: Between 1996 and 2004, a total of 149 patients with diabetic retinopathy underwent revascularization, either coronary artery bypass surgery (CABG) (n=56) or percutaneous coronary intervention with bare metal stents (BMS) (n=94). We compared overall survival rates of the two methods. Mortality was estimated according to Kaplan-Meier methods and was compared using the log-rank test. Results: The average follow-up from the time of the initial revascularization was 59.7 ± 33.3 months. During the entire follow-up, there was 8(14.5%)death in the CABG group and 27(28.7%) deaths in the BMS group. The average duration between death and revascularization was 81.3 ± 24.6 for the CABG group and 29.9 ± 23.8 for the BMS group (P<0.001). The 6-year overall survival was 94.8% for the CABG group and 73.6% for the BMS group. Mortality curves differed significantly between the two groups (P=0.004) (Figure ). After adjustment for baseline characteristics including age, sex, HbA1c, insulin, serum creatinine, ejection fraction, and the extent of coronary disease, the hazard ratio of death afforded by CABG was 0.36 (95% confidence interval, 0.15–0.87; P=0.023). Conclusions: In patients with diabetic retinopathy, CABG conferred survival benefit over BMS implantation.

scholarly journals Questions of the mathematical modeling of the progression of coronary heart disease in patients with type 2 diabetes mellitus

2020 ◽  
Vol 7 (5) ◽  
pp. 128-131
Author(s):  
Yulduz Makhkamovna Urmanova ◽  
Shakhnoza Shokirjonovna Mukhtarova ◽  
Tursunkulov Ortikali ◽  
Margarita Zairganovna Mukhtarova ◽  
Kholikov Farkhod Jamoliddin Ugli
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Coronary Heart Disease ◽  
Type 2 Diabetes Mellitus ◽  
Heart Disease ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Surgical Interventions ◽  
The Moment

In 2017-2019, 40 patients were examined (16 of them men, 24 women) with type 2 diabetes mellitus in combination with IHD, of which 38 patients had a favorable course and 8 with an unfavorable course. For an unfavorable profile, the presence of strokes, mycocardial infarction (fatal, nonfatal), repeated hospitalizations for worsening chronic heart failure (decrease in ejection fraction), repeated surgical interventions (percutaneous coronary intervention, coronary artery bypass grafting) for the current 3 years was taken into account. The average age of patients was 65.5 years. In total, 119 signs recorded in the first three days from the moment of patient's arrival were analyzed as possible predictors of an unfavorable prognosis. From this whole set, a number of parameters with corresponding values ​​were selected as markers of coronary heart disease, which showed the highest incidence rate in the group of patients with adverse course (NBT) and the highest in the group of patients with favorable course (BT). the most pathognomonic predictors of IHD progression in patients with type 2 diabetes were systolic LV dysfunction (fv <40%), SBP> 160 mm Hg and/or DBP above 100 mm Hg. Art., severe angina pectoris, LVH and ECG signs of myocardial ischemia, persisting upon discharge from the hospital, history of ACVA comorbidity plus DM-2.

scholarly journals The Importance of Heart Rehabilitation for Coronary Heart Disease Patients

2019 ◽  
Vol 15 (1) ◽  
pp. 07
Author(s):  
Muhammad Husein
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Treatment Protocol ◽  
Coronary Intervention ◽  
Mortality And Morbidity ◽  
Rehabilitation Programs ◽  
Artery Graft ◽  
Appropriate Treatment ◽  
Monitoring Process

Coronary heart disease has now become a global cardiovascular problem with a high mortality rate. Regarding the mortality and morbidity rates of patients with high myocardial infarction, appropriate treatment is needed for patients. Three interventions were performed on coronary heart disease patients, thrombolytic interventions, percutaneous coronary intervention, and coronary artery graft bypass (CABG). Cardiac Rehabilitation is a treatment protocol recommended for the treatment of heart disease, and has been developed from a simple multidisciplinary sponsored patient monitoring process that requires patient education, specially designed exercise programs, modification of patient risk factors, and patient benefits. Identifying incentive programs will increase the level of participation in rehabilitation programs, to help patients achieve the main benefits of cardiac rehabilitation

scholarly journals CARBOHYDRATE METABOLISM DISORDERS AND CORONARY HEART DISEASE: PROGNOSTIC VALUE AND REVASCULARISATION EFFECTIVENESS

2013 ◽  
Vol 12 (3) ◽  
pp. 79-84
Author(s):  
L. V. Kremneva ◽  
T. S. Pursanova ◽  
O. V. Abaturova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Carbohydrate Metabolism ◽  
Prognostic Value ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Myocardial Revascularisation ◽  
Percutaneous Coronary

This literature review presents the data on the prevalence and prognostic value of carbohydrate metabolism disorders, such as Type 2 diabetes mellitus (DM) and pre-diabetes — fasting hyperglycaemia and impaired glucose tolerance), among patients with coronary heart disease (CHD). The authors present the results of large studies on comparative effectiveness of modern pharmacological treatment and myocardial revascularisation (percutaneous coronary intervention and coronary artery bypass graft surgery) in patients with CHD and DM. 

scholarly journals Análise da Revisão Cochrane: Reabilitação Cardíaca Baseada no Exercício na Doença Arterial Coronária. Cochrane Database Syst Rev. 2016;1:CD001800

2019 ◽  
Vol 32 (7-8) ◽  
pp. 483
Author(s):  
Rita Carvalheira-dos-Santos ◽  
Ricardo-Manuel Delgado ◽  
Guilherme Ferreira-dos-Santos ◽  
António Vaz-Carneiro
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Hospital Admissions ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cochrane Review ◽  
Total Mortality

Coronary heart disease is the single most common cause of death globally, accounting for one-third of all deaths. However, with falling coronary heart disease mortality rates, an increasing number of people live with the disease and may need support to manage their symptoms and prognosis. A complex intervention that may involve a variety of therapies, cardiac rehabilitation includes exercise, risk factor education, behavioral change, psychological support, and strategies that are aimed at targeting traditional risk factors for cardiovascular disease. Cardiac rehabilitation is an essential part of contemporary heart disease care and is considered a priority in countries with a high prevalence of coronary heart disease. This Cochrane systematic review constitutes an update of a Cochrane review published in 2011, having identified 16 new trials (3872 participants), predominantly post-myocardial infarction and post-revascularization patients. Therefore, it included 63 randomized trials looking at the effectiveness and cost-effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease. The quality of the evidence ranged from low to moderate. The main results highlight the effect of cardiac rehabilitation, in comparison with absence of physical exercise, in the reduction in cardiovascular mortality, with no reduction, however, in total mortality. The overall risk of hospital admissions was reduced with cardiac rehabilitation but there was no significant impact on the risk of myocardial infarction, coronary artery bypass graft or percutaneous coronary intervention. This paper aims to summarize and discuss the main results and conclusions of this systematic review, as well as its implications for the daily clinical practice.

scholarly journals World War II cohorts and diabetes mellitus, coronary heart disease and cerebrovascular disease later in life: An observational cohort study based on German claims data

2020 ◽  
Author(s):  
Thomas Fritze ◽  
Constantin Reinke ◽  
Gerard J. van den Berg ◽  
Gabriele Doblhammer
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
World War Ii ◽  
Claims Data ◽  
Recursive Partitioning ◽  
Health Claims ◽  
Birth Cohorts ◽  
World War ◽  
Health Claims Data ◽  
Linear Splines

AbstractBackgroundThis study applied a data-driven approach to explore whether being born during or around World War II affects the risk of morbidity later in life.MethodsIncident diagnoses were explored for diabetes (ICD-10 code E10-E14; 75,487 persons/12,905 incident cases), cerebrovascular disease (CeVD; I6; 79,829/11,664), and coronary heart disease (CHD; I20-I25; 89,657/11,116) for birth cohorts 1935-1950, using German health-claims data from 2004-2015. The data include quarterly information of the inpatient and outpatient treatment. We applied recursive partitioning methods with the aim of splitting the sample into birth cohorts with different risk profiles in terms of the incidence of diabetes, CeVD, and CHD. We performed Cox proportional hazard models to explore the transition into diabetes, CeVD, and CHD, accounting for birth cohort and gender. We used the median cut-points from the recursive partitioning analysis on the birth cohort indicator to define linear splines and present the yearly slopes of the linear splines.ResultsBased on the results from recursive partitioning method we defined four groups of birth cohorts depending on the disease of interest (diabetes: 1/35-10/37, 11/37-11/41, 12/41-10/44, 11/44-12/50; CHD: 1/35-5/37, 6/37-4/41, 10/44-12/50; CeVD: 1/35-6/37, 7/37-6/40, 7/40-12/43, 1/44-12/50). We found a general decline in cohort incidence for all three diseases, however, there was a discontinuation for diabetes among birth cohorts 12/41-10/44 (yearly slope=-0.01, p=0.584), and a deceleration for cohorts 11/44-12/50 for CeVD.ConclusionsWe identified risk periods associated with WWII that interfered with the cohort decline in the risk of diabetes and CeVD, stressing the importance of a beneficial early-life environment.Availability of dataThe scientific research institute of the AOK (WIdO) has strict rules regarding data sharing because of the fact that health claims data are a sensible data source and have ethical restrictions imposed due to concerns regarding privacy. Anonymized data are available to all interested researchers upon request. Interested individuals or an institution who wish to request access to the health claims data of the AOK, please contact the WIdO (webpage: http://www.wido.de/, mail: [email protected]).

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