Socioeconomic status, secondary prevention activities during the first year after a myocardial infarction and target attainments

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Ohm ◽  
P.H Skoglund ◽  
H Habel ◽  
J Sundstrom ◽  
K Hambraeus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Socioeconomic Status ◽  
Secondary Prevention ◽  
Recurrent Events ◽  
Strong Predictor ◽  
Statin Treatment ◽  
City Council ◽  
First Year ◽  
Funding Source ◽  
Prevention Activities

Abstract Background Socioeconomic status (SES) is a strong predictor of recurrent events post-myocardial infarction (MI) with unclear underlying mechanisms. To what extent SES is associated with secondary prevention activities (SPAs) and attainment of quality-of-care treatment goals is unknown. Purpose We aimed to assess the association between SES and SPAs during the first year post-MI and attained treatment targets at the 1-year follow-up. Methods Nationwide Swedeheart registry-based cohort study on 30,191 18–76 year old 11–15 month survivors of a first MI (8,180 women) 2006–2013. Complementary individual-level clinical data and data on SES (age and gender stratified quintiles of disposable income, level of education, and marital status), were linked from other national registries. Associations between SES and the outcomes were estimated in multivariable logistic regression models with basic adjustment for potential registry-related confounding. Results The associations between all indicators of SES and attendance to patient education and physical training programs were strong, moderate for dietary program attendance but absent for participation in smoking cessation program (Table 1). Higher SES was also associated with repeated lipid profile measurements and the highest vs lowest income with intensified statin therapy. Correspondingly, higher SES was associated with having achieved target levels of LDL-C, blood pressure, and HbA1c as well as with persistence to and being on high intensity statin treatment (Figure 1). Further, higher SES was strongly associated with having quit smoking. No association with income was however observed regarding the weekly physical activity goal. Conclusions Higher SES was strongly associated with most SPAs including programs aiming at life style change and risk factor control as well as with attainment of corresponding secondary prevention targets. This may be explanatory for higher long-term risk of recurrent disease. Figure 1. Target Attainment Forest Plots Funding Acknowledgement Type of funding source: Other. Main funding source(s): Stockholm City Council and The Swedish Heart and Lung Association

Coronary lesion complexity in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the French RICO Survey

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Yao ◽  
M Farnier ◽  
C Salignon-Vernay ◽  
F Chague ◽  
P Brunel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Statin Treatment ◽  
Public Institution ◽  
Syntax Score ◽  
Funding Source ◽  
Lipid Clinic ◽  
Complex Anatomy ◽  
Acute Mi ◽  
Artery Disease

Abstract Background Although patients with familial heterozygous hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI), coronary artery disease (CAD) burden of FH patients with acute MI remains to be investigated. Methods All consecutive patients hospitalized for an acute MI in a multicenter database (RICO) from 2012–2017 who underwent coronary angiography were considered. FH (n=86) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥6). The angiographic features of FH patients were compared with patients without FH (score 0–2) (n=166), after matching for age, sex and diabetes (1:2). Results When compared with patients without FH, patients with FH had higher prevalence of personal and familial history of CAD (17 vs 5%, and 74 vs 5%, p=0.002 and p<0.001, respectively), and hypertension (54 vs 36%, p=0.006). Chronic statin treatment was used in only 45% of FH patients. At coronary angiography, FH had increased extent of CAD (SYNTAX score 11 (4–21) vs 8 (3–16), p=0.049) and multivessel disease (58% vs 43%, p=0.021). Significant stenosis was more frequent in left and right marginal coronary arteries. FH patients showed a trend toward more complex lesions, with less thrombus (28 vs 39%, p=0.076), but a 2 times higher rate of bifurcation lesions and calcifications (23 vs 12% and 20 vs 10%, p=0.021 and p=0.036). Conclusions This study addressing the coronary lesions features of FH patients with acute MI shows that FH patients had more severe CAD burden, and were characterized by complex anatomy features. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté, CHU Dijon Bourgogne

scholarly journals High thrombotic risk increases adverse clinical events up to 5 years after acute myocardial infarction. A nationwide retrospective cohort study

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Gian Francesco Mureddu ◽  
Cesare Greco ◽  
Stefano Rosato ◽  
Paola D'Errigo ◽  
Leonardo De Luca ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Recurrent Events ◽  
First Year ◽  
Thrombotic Risk ◽  
Clinical Events ◽  
Cerebrovascular Events

The risk of recurrent events among survivors of acute myocardial infarction (AMI) is understudied. The aim of this analysis was to investigate the role of residual high thrombotic risk (HTR) as a predictor of recurrent in-hospital events after AMI. This retrospective cohort study included 186,646 patients admitted with AMI from 2009 to 2010 in all Italian hospitals who were alive 30 days after the index event. HTR was defined as at least one of the following in the 5 years preceding AMI: previous myocardial infarction, ischemic stroke/other vascular disease, type 2 diabetes mellitus, renal failure. Risk adjustment was performed in all multivariate survival analyses. Rates of major cardiac and cerebrovascular events (MACCE) within the following 5 years were calculated in both patients without fatal readmissions at 30 days and in those free from in-hospital MACCE at 1 year from the index hospitalization. The overall 5-year risk of MACCE was higher in patients with HTR than in those without HTR, in both survivors at 30 days [hazard ratio (HR), 1.49; 95% confidence interval (CI), 1.45-1.52; p<0.0001] and in those free from MACCE at 1 year (HR, 1.46; 95% CI, 1.41-1.51; p<0.0001). The risk of recurrent MACCE increased in the first 18 months after AMI (HR, 1.49) and then remained stable over 5 years. The risk of MACCE after an AMI endures over 5 years in patients with HTR. This is also true for patients who did not have any new cardiovascular event in the first year after an AMI. All patients with HTR should be identified and addressed to intensive preventive care strategies.

scholarly journals IL-1β and Statin Treatment in Patients with Myocardial Infarction and Diabetic Cardiomyopathy

2019 ◽  
Vol 8 (11) ◽  
pp. 1764 ◽  
Author(s):  
Liberale ◽  
Carbone ◽  
Camici ◽  
Montecucco
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Diabetic Cardiomyopathy ◽  
Statin Treatment ◽  
Preventive Therapy ◽  
Lipid Lowering ◽  
Current Evidence ◽  
Inflammatory Microenvironment ◽  
First Line Therapy ◽  
Beneficial Impact

Statins are effective lipid-lowering drugs with a good safety profile that have become, over the years, the first-line therapy for patients with dyslipidemia and a real cornerstone of cardiovascular (CV) preventive therapy. Thanks to both cholesterol-related and “pleiotropic” effects, statins have a beneficial impact against CV diseases. In particular, by reducing lipids and inflammation statins, they can influence the pathogenesis of both myocardial infarction and diabetic cardiomyopathy. Among inflammatory mediators involved in these diseases, interleukin (IL)-1β is a pro-inflammatory cytokine that recently been shown to be an effective target in secondary prevention of CV events. Statins are largely prescribed to patients with myocardial infarction and diabetes, but their effects on IL-1β synthesis and release remain to be fully characterized. Of interest, preliminary studies even report IL-1β secretion to rise after treatment with statins, with a potential impact on the inflammatory microenvironment and glycemic control. Here, we will summarize evidence of the role of statins in the prevention and treatment of myocardial infarction and diabetic cardiomyopathy. In accordance with the dual lipid-lowering and anti-inflammatory effect of these drugs and in light of the important results achieved by IL-1β inhibition through canakinumab in CV secondary prevention, we will dissect the current evidence linking statins with IL-1β and outline the possible benefits of a potential double treatment with statins and canakinumab.

Time from ECG Diagnosis to sheath insertion is a strong predictor for mortality in patients with ST elevation myocardial infarction admitted for primary percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.I Larsen ◽  
K Loland ◽  
S Hovland ◽  
O Bleie ◽  
T Trovik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Strong Predictor ◽  
Public Institution ◽  
St Elevation Myocardial Infarction ◽  
University Hospital ◽  
P Value ◽  
Funding Source ◽  
Invasive Cardiology ◽  
St Elevation ◽  
Sheath Insertion

Abstract Introduction If reperfusion can be performed within 120 minutes, pPCI is the ESC guideline recommended treatment in patients with ST-elevation myocardial infarction (STEMI). Aims Historically, prognosis is dependent on time from diagnosis to reperfusion in patients with STEMI. We sought to investigate this in a contemporary patient population by assessing mortality as function of time from ECG diagnosis to sheath insertion in the Norwegian registry for invasive cardiology (NORIC). Methods NORIC, which is a part of the Norwegian Cardiovascular Disease Registry, is a national, mandatory and non-consensual person-identifiable health registry. Data from NORIC were linked with the National Population Register. Data were registered from 1st of January 2013 to 31st of June 2019. Results During this period complete data were available for n=5754 patients with 526 events. ECG diagnosis to sheath insertion was a predictor of mortality with the 4th (&gt;106 min) vs 1st quartile (&lt;54 min) with a HR of 1.74 (95% CI 1.36–2.22), p-value &lt;0.00001. The HR increased by 1.20 (95% CI 1.11–1.30) per quartile (p-value for trend &lt;0.00001). Nationally 62% percent of the patients received pPCI within the ESC recommended 90 minutes from ECG-diagnosis with large geographical variation (range 38–89%). Nationally 80% received pPCI within 115 minutes (range 75–202 minutes). Conclusion In a contemporary STEMI population, time from ECG diagnosis to sheath insertion is a strong predictor for mortality in patients admitted for pPCI for STEMI. However, the data also demonstrate large variations between different geographical health regions in Norway that should be addressed. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Haukeland University Hospital

scholarly journals Features of secondary prevention in young STEMI patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Bilyi ◽  
A N Parkhomenko ◽  
O I Irkin ◽  
Y M Lutai ◽  
A O Stepura ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Young Patients ◽  
Cardiovascular Death ◽  
First Year ◽  
Combination Drug ◽  
Funding Sources ◽  
Long Time ◽  
Remote Observation

Abstract   Among patients who underwent a myocardial infarction (MI), one in five patients has a second cardiovascular event (MI, acute cerebrovascular accident, arrhythmias, etc.) during the first year, even with optimal treatment and care. Young patients often do not take the prescribed treatment or do not take it for a long time after discharge from the hospital. The issue of secondary prevention among the population is well studied, while in the literature such data for young people are lacking. Methods The data of 160 STEMI young patients (18–46 years) who admitted and treated in the intensive care unit were evaluated. We studied the effect of the main groups of medicines on the course of AMI in young patients. The remote observation lasted 5 years after discharge from the hospital. The following cardiovascular events during 1 (365 days), 2 (730 days), 3 (1095 days), and 5 years (1800 days) of the FU were used as the endpoint: death from any cause, combined endpoint (cardiovascular death, myocardial infarction, stroke, revascularization (CABG, stenting). Results It was noted that taking one of the antithrombotic drugs (clopidogrel or ticagrelor) in young patients, after 2, 3, and 5 years of follow-up, significantly affected the development of the combined endpoint, reducing the number of events (p=0.013, p=0.004 and p=0.048, respectively). Statins had a better effect on the number of combined endpoints (reduced their number) in young patients during 2-year and 3-year follow-up (p=0.041) and (p=0.034), respectively. In young patients, ACEI or ARB tended to influence the development of a combined endpoint at 2, 3, and 5 years of follow-up (p=0.061, p=0.080, and p=0.067, respectively). In our study, we found that taking aspirin at a dose of 75–100 mg tends to reduce the development of death from any cause (p=0.054) within 5 years (1800 days) from discharge. Patients under 45 years after undergoing AMI were significantly less likely to take the minimum necessary medication, like aspirin, and statins than older patients (45–65 years) (24.2% vs. 42%, p&lt;0.001, respectively). Conclusion Young patients after AMI for secondary prevention must take an antithrombotic drug (clopidogrel or ticagrelor), statins, and an ACEI or ARB. In order to increase compliance, it is recommended to take a combination drug. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Association of Socioeconomic Status With Risk Factor Target Achievements and Use of Secondary Prevention After Myocardial Infarction

2021 ◽  
Vol 4 (3) ◽  
pp. e211129
Author(s):  
Joel Ohm ◽  
Per H. Skoglund ◽  
Henrike Häbel ◽  
Johan Sundström ◽  
Kristina Hambraeus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Socioeconomic Status ◽  
Risk Factor ◽  
Secondary Prevention

Determinants of statin initiation and discontinuation in the secondary prevention of atherosclerotic cardiovascular disease in Scotland during 2009–2017

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Thalmann ◽  
D Preiss ◽  
I Schlackow ◽  
A Gray ◽  
B Mihaylova
Keyword(s):  
Mental Health ◽  
Cardiovascular Disease ◽  
Secondary Prevention ◽  
Older People ◽  
Statin Therapy ◽  
High Intensity ◽  
Patient Characteristics ◽  
Statin Treatment ◽  
Funding Source ◽  
Multiple Morbidities

Abstract Background Previous studies have shown that use of statins for secondary prevention of cardiovascular disease (CVD) is suboptimal. However, the role of particular individual characteristics at different treatment stages is limited. Purpose To use large-scale population-wide individual patient data to investigate reasons for suboptimal use of effective CVD medications, in order to identify patient groups that could be targeted to improve medication adherence. Methods This observational longitudinal study used anonymised linked NHS Scotland administrative data (General/Acute Inpatient and Day Case, the National Records of Scotland and the Prescribing Information System) for all individuals hospitalised for an atherosclerotic CVD event (based on ICD-10 discharge codes) in Scotland between 1 April 2009 and 31 December 2017. Statin initiation was defined as individuals being prescribed statin therapy within 90 days from index discharge and dispensed within 60 days from that prescription. Discontinuation was defined as the start of first statin treatment gap of 180 days or more since initiation. Multivariate logistic regression and Cox proportional hazards models were used to study the relevance of patient characteristics (e.g. demographic, clinical, socio-economic) and admission calendar year to the likelihood of, respectively, initiating or discontinuing statin treatment. Findings are reported for all CVD events and, separately, for myocardial infarction (MI), ischaemic stroke (IS) and peripheral arterial disease (PAD). Results Of the 178,113 patients hospitalised for CVD, 19% did not initiate statin treatment. Among the 144,077 patients initiating (40% on high-intensity statins, as defined by NICE guidelines), 25% discontinued treatment within 2 years. Initiation was less common in women (29% less likely than men), older people (22% and 50% less likely for patients in their 70s and 80s respectively vs. 60s), people living in more deprived areas, people receiving specialist mental health care, people with multiple morbidities and people not taking statin prior to admission (Figure). Most of these characteristics were also associated with a decreased likelihood of initiating high-intensity statins, as well as an increased risk of discontinuing statin therapy. In later years, levels of statin initiation, including on higher-intensity statins (58% of statin initiators in 2015–17 vs. 32% in 2009–11), and statin persistence have improved. Conclusions Rates of statin initiation and discontinuation remain suboptimal, especially among women, older people and people with multiple morbidities or mental health illness. Figure 1. Patient characteristics associated with initiation and discontinuation of statin treatment after atherosclerotic CVD event. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation Centre of Research Excellence (Pump Priming Scheme), Medical Research Council UK

Socioeconomic status predicts second cardiovascular event in 29,226 survivors of a first myocardial infarction

2018 ◽  
Vol 25 (9) ◽  
pp. 985-993 ◽  
Author(s):  
Joel Ohm ◽  
Per H Skoglund ◽  
Andrea Discacciati ◽  
Johan Sundström ◽  
Kristina Hambraeus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Socioeconomic Status ◽  
Secondary Prevention ◽  
Marital Status ◽  
Preventive Treatment ◽  
Disposable Income ◽  
Atherosclerotic Cardiovascular Disease ◽  
One Year ◽  
First Myocardial Infarction

Background Risk assessment post-myocardial infarction needs improvement, and risk factors derived from general populations apply differently in secondary prevention. The prediction of subsequent cardiovascular events post-myocardial infarction by socioeconomic status has previously been poorly studied. Design Swedish nationwide cohort study. Methods A total of 29,226 men and women (27%), 40–76 years of age, registered at the standardised one year revisit after a first myocardial infarction in the secondary prevention quality registry of SWEDEHEART 2006–2014. Personal-level data on socioeconomic status measured by disposable income and educational level, marital status, and the primary endpoint, first recurrent event of atherosclerotic cardiovascular disease, defined as non-fatal myocardial infarction or coronary heart disease death or fatal or non-fatal stroke were obtained from linked national registries. Results During the mean 4.1-year follow-up, 2284 (7.8%) first recurrent manifestations of atherosclerotic cardiovascular disease occurred. Both socioeconomic status indicators and marital status were associated with the primary endpoint in multivariable Cox regression models. In a comprehensively adjusted model, including secondary preventive treatment, the hazard ratio for the highest versus lowest quintile of disposable income was 0.73 (95% confidence interval 0.62–0.83). The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was stronger in men as was the risk associated with being unmarried (tests for interaction P < 0.05). Conclusions Among one year survivors of a first myocardial infarction, first recurrent manifestation of atherosclerotic cardiovascular disease was predicted by disposable income, level of education and marital status. The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was independent of secondary preventive treatment but further study on causal pathways is needed.

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