scholarly journals Post-myocardial transitional care in Poland - single centre experience with novel Coordinated Comprehensive Care programme – clinical and laboratory follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Telec ◽  
H Krysztofiak ◽  
P Kalmucki ◽  
A Baszko ◽  
A Szyszka
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Transitional Care ◽  
Laboratory Data ◽  
Rehabilitation Program ◽  
Comprehensive Care ◽  
Invasive Treatment ◽  
Care Programme ◽  
The Impact

Abstract Background Cardiac rehabilitation (CR) is an inherent part of the transitional care after acute myocardial infarction (AMI). Polish health care system has created a novel Coordinated Comprehensive Care Program after AMI, which ensures outpatient follow-ups, further invasive treatment and free-of-charge CR for all patients after acute MI. Purpose The aim of the study was to analyze the impact of CR on clinical and laboratory characteristics of the patients who completed the recommended programme. Methods 118 participants were enrolled. They were divided into two groups, depending on the criterium of completion (rehabilitation group) or non-completion (no rehabilitation group) of the CR. The clinical and laboratory data at discharge and after 12 months were collected and analyzed in both groups. Results The majority of the patients (n=83, 70,3%) underwent CR. This group was younger in comparison to patients who did not participate in CR (63.0±8.6 vs. 69.8±8.7 years; p<0.01). Index hospitalization was significantly shorter in rehabilitation group (7 vs. 8 days, respectively; p<0,04). LDL-C reduction was observed in both groups, but only rehabilitation group presented statistically significant reduction (median LDL at discharge 108,5 vs. 67,0 mg/dl at follow-up; p<0.01). No rehabilitation group had LDL-C non-significantly decreased (p=0.16). NT-proBNP decreased in both groups over 12 months, but only rehabilitation group had significant reduction (median 590,0 pg/ml at discharge vs. 199,0 at follow-up; p<0.01). Laboratory follow-up is summarized in Figure 1. BMI increased in both groups, with statistical importance in rehabilitation group (p<0,01). Conclusions Post-myocardial rehabilitation is more frequently prescribed to younger patients with shorter index hospitalisation. Clinical and laboratory parameters improve more in the group that underwent CR programme and this might warant more effort on increasing CR accessibility and patient enrollement. The phenomenon of weight gain in patients after acute myocardial infarction independently from undergoing rehabilitation program or not needs further research. Figure 1. 12-month laboratory follow-up. Funding Acknowledgement Type of funding source: None

P2518Failure of completion of post-myocardial infarction rehabilitation programme - Who and why? Single center experience with novel Coordinated Comprehensive Care program in Poland

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Telec ◽  
P Kalmucki ◽  
H Krysztofiak ◽  
A Szyszka ◽  
A Baszko
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Laboratory Data ◽  
Care Program ◽  
Rehabilitation Programme ◽  
Comprehensive Care ◽  
Invasive Treatment ◽  
Laboratory Test Results ◽  
Number Of Patients

Abstract Background Rehabilitation after acute myocardial infarction is a well-proven strategy to improve outcomes and reduce complications rate. Poland recently introduced a novel, fully-reimbursed Coordinated Comprehensive Care (CCC) program after myocardial infarction, a significant portion of which comprises access to free-of-charge cardiac rehabilitation. Purpose The purpose of the study was to analyze all patients qualified for the Coordinated Comprehensive Care Program and evaluate reasons for not completing rehabilitation. We compared two groups of patients - those who completed the rehabilitation and those that did not - in terms of clinical, demographic and laboratory characteristics. Methods All patients (n=169) referred from the cardiology department for the CCC program were included in the study. They were divided into two groups, depending on single, strict criterium of completion or non-completion of the rehabilitation program. Demographic, clinical and laboratory data were collected and analyzed. Results The majority of the patients (n=100, 59.2%) did not undergo cardiac rehabilitation. 61 of them were not qualified for rehabilitation programme by the consortium of doctors: 33 of them due to the need for further invasive treatment, the remainder 28 were disqualified due to severe comorbidities. 32 patients did not commence the program despite referral and encouragement, mostly (n=25) due to personal reasons, 7 patients did not specify reasons for not participating in the rehabilitation. 7 patients were lost to follow-up. Patients who completed rehabilitation (n=69, 40.8%) were younger that those who did not (64.4±9.8 vs. 67.1±9.5 years, respectively; p=0.076), had significantly higher baseline LVEF (49.1±9.4 vs. 44.7±11.9%, p<0.03), and had lower serum creatinine level (0.99±0.28 vs. 1.15±0.59 mg/dl; p<0.03). There were more patients with LVEF<35% (n=23; 23%) in the no-rehabilitation, than in the other group (n=5; 7.25%; p<0.01). Rehabilitation completed (n=69) Rehabilitation NOT completed (n=100) p Gender – male 40 (35.4%) 73 (64.6%) <0.05 LVEF- % 49.12 (±9.43) 44.69 (±11.97) <0.03 No. of patients with EF <35% 5 (7.25%) 23 (23%) <0.01 Conclusion Although fully-reimbursed cardiac rehabilitation is provided for all patients following acute myocardial infarction, there is a significant number of patients who fail to complete the programme. This group comprises more male patients with worse clinical and laboratory test results, especially LVEF and renal function. Efforts should be made to address the problem and modify the programme accordingly.

Feasibility of hybrid telerehabilitation as component of a novel comprehensive care program after acute myocardial infarction in a one-year follow-up preliminary experience of a single center

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
E Piotrowicz ◽  
P Orzechowski ◽  
I Kowalik ◽  
R Piotrowicz
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Functional Capacity ◽  
Care Program ◽  
Comprehensive Care ◽  
Monitoring Center ◽  
One Year

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 &lt;0.001 Maximal workload [MET] 7.9 ± 1.8 10.1 ± 2.3 &lt;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 &lt;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.

Long term prognostic impact of gender in patients with stable coronary disease: an analysis of the CICCOR registry, a seventeen years, prospective, monocentric, cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Ruiz Ortiz ◽  
J.J Sanchez Fernandez ◽  
C Ogayar Luque ◽  
E Romo Penas ◽  
M Delgado Ortega ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Cardiovascular Death ◽  
Female Sex ◽  
The Impact ◽  
Overall Mortality

Abstract Purpose Women and men with stable coronary artery disease (sCAD) have different clinical features and management, but 1-year prognosis has been reported to be similar in large observational registries. The objective of the present study was to investigate the impact of female sex in the prognosis of the disease in the very long-term. Methods The CICCOR registry (“Chronic ischaemic heart disease in Cordoba”) is a prospective, monocentric, cohort study. From February 1, 2000 to January 31, 2004, all consecutive patients with sCAD attended at two outpatient cardiology clinics in a city of the south of Spain were included in the study and prospectively followed. Differential clinical features of women and men were described and the impact of female sex in long term prognosis was investigated. Results The study sample included 1268 patients, 337 women (27%) and 931 men (73% male). Women were older than men (70±9 versus 65±11 years, p&lt;0.0005), more likely to have hypertension (72% versus 49%, p&lt;0.0005) and diabetes (45% versus 26%), and less likely to be ex-smoker/active smoker (5%/2% versus 49%/9%, p&lt;0.0005). They had more frequently angina in functional class ≥II (22% versus 17%, p=0.04) and atrial fibrillation (8% versus 5%, p=0.04), but had received less frequently coronary revascularization (32% versus 44%, p&lt;0.0005). Prescription of statins (64% versus 68%, p=0.22), antiplatelets (89% versus 93%, p=0.07) and betablockers (67% versus 63%, p=0.28) at first visit was similar than men, but women received more frequently nitrates (78% versus 64%, p&lt;0.0005), angiotensin-conversing enzyme inhibitors or receptor antagonists (56% versus 47%, p=0.004) and diuretics (41% versus 22%, p&lt;0.0005). After up to 17 years of follow-up (median 11 years, IQR 4–15 years, with a total of 12612 patients-years of observation), probabilities of acute myocardial infarction (12% versus 14%, p=0.55) or stroke (14% versus 12%, p=0.40) at median follow up were similar for women and men. However, the risks of hospital admission for heart failure (22% versus 13%, p&lt;0.0005) or cardiovascular death (35% versus 24%, p&lt;0.0005) were significantly higher for women, with a non-significant trend to higher overall mortality (45% versus 39%, p=0.07). After multivariate adjustment, the risks of most events were similar for women and men (Hazard Ratios [95% confidence intervals]: 0.79 [0.55–1.14], p=0.21 for acute myocardial infarction; 0.89 [0.61–1.29], p=0.54 for stroke; 1.13 [0.82–1.57], p=0.46 for admission for heart failure; and 0.92 [0.73–1.16], p=0.48 for cardiovascular death), with a non-significant trend to lower overall mortality (0.83 [0.67–1.02], p=0.08). Conclusion Although women and men with sCAD presents a different clinical profile, and crude rates of hospital admissions for heart failure and cardiovascular death were higher in women, female sex was not an independent prognostic factor in this observational study with up to 17 years of follow-up. Funding Acknowledgement Type of funding source: None

scholarly journals Impact of a Preexisting STEMI Network in Improving STEMI Diagnostic and Treatment in the Community after the Introduction of a National Program of Interventional Treatment in Acute myocardial Infarction

2015 ◽  
Vol 1 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Marius Orzan ◽  
Theodora Benedek ◽  
Balázs Bajka ◽  
Kinga Pál ◽  
Nora Rat ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Interventional Treatment ◽  
Primary Pci ◽  
National Program ◽  
Treatment Rate ◽  
Invasive Treatment ◽  
European Guidelines ◽  
The Impact ◽  
Related Mortality

Abstract Introduction: According to European guidelines, ST elevation acute myocardial infarction should be treated by immediate reperfusion, if diagnosed within 12 hours from the onset of symptoms. We aimed to show the impact of a well-functioning pre-existing STEMI network in improving the results of a national program dedicated to the invasive treatment of AMI. Methods: We followed the comparison between primary PCI rates and STEMI-related mortality in two regions, after the introduction of a nationwide program for the interventional treatment of acute myocardial infarction: region A, where the territory has been appropriately prepared via previous organizational measures in the network, and region B, where the territory has not been previously prepared. Results: In 2011, one year after the initiation of the national program, a primary PCI rate of 12.1%, a thrombolysis rate of 10.1% and a no-reperfusion treatment rate of 77.8% have been found in these new centers for patients arriving <12 h from symptoms onset. This has been reflected in a mortality of 23.07% for “early presentations” in these new centers in 2011. In comparison, data from the territorial hospitals of the registry (only those without cathlab facilities, similar to the new centers) showed in 2011 a 73.85% primary PCI rate, 12.09% thrombolysis rate and a 14.07% conservative treatment rate, reflected in a mortality of 6.81% for “early presentations” in the registry centers. Conclusions: The national strategy for reduction of STEMI related mortality via implementation of primary PCI, started in 2010, had a significant impact especially in that region where the territory was previously prepared with appropriate organizational efforts, including educational and logistic measures.

scholarly journals Survival Benefit of the Late Percutaneous Coronary Intervention in the Patients after Acute Myocardial Infarction Who Are Or Who Are Not Treated with Thrombolysis

2009 ◽  
Vol 9 (1) ◽  
pp. 54-58
Author(s):  
Božidarka Knežević ◽  
Nebojša Bulatović ◽  
Nataša Belada ◽  
Vesna Ivanović ◽  
Siniša Dragnić ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
One Year ◽  
The Impact

The impact of late percutaneous coronary intervention (PCI) in the patients after acute myocardial infarction (AMI) on long term mortality remains to be established. At currently, thrombolysis is accepted as standard therapy when PCI is not immediately available. However, PCI is often performed in stable patients with AMI who are/are not received thrombolysis .We performed the trial that enrolled myocardial infarction patients treated with thrombolysis, late PCI and medically to assess the potential benefits of delayed PCI. We follow up 164 consecutive patients after AMI one year. The patients are divided in two groups; first group-66 patients who received reperfusion (37 patients received only thrombolysis, 10 patients received thrombolysis and PCI 7-9 days after thrombolysis and 19 patients underwent only PCI after 7-9 days) and second group-98 patients medically treated. One year mortality was 3% in the reperfusion group (2/66) and 14,3% in the medical group (14/98) (p=0,016). There were not significant differences between groups about other end points-reinfarctus, coronary artery bypass surgery and PCI performed later after discharge. The major predictors of one year mortality were ages (p<0,001) and ejection fraction (p=0,003). Also, therapy with beta-blockers (p=0,002), statins (p=0,001) and ACE-inhibitors (p=0,024) was associated with better survival. Delayed PCI performed 7-9 days after AMI in the patients who underwent thrombolysis or those did not improves outcome at long-term follow-up

scholarly journals Adjunctive Cilostazol to Dual Antiplatelet Therapy to Enhance Mobilization of Endothelial Progenitor Cell in Patients with Acute Myocardial Infarction: A Randomized, Placebo-Controlled EPISODE Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1678
Author(s):  
Yongwhi Park ◽  
Jin Hyun Kim ◽  
Tae Ho Kim ◽  
Jin-Sin Koh ◽  
Seok-Jae Hwang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Controlled Trial ◽  
Endothelial Progenitor ◽  
Double Blind ◽  
The Impact

Background: Endothelial progenitor cells (EPCs) have the potential to protect against atherothrombotic event occurrences. There are no data to evaluate the impact of cilostazol on EPC levels in high-risk patients. Methods: We conducted a randomized, double-blind, placebo-controlled trial to assess the effect of adjunctive cilostazol on EPC mobilization and platelet reactivity in patients with acute myocardial infarction (AMI). Before discharge, patients undergoing percutaneous coronary intervention (PCI) were randomly assigned to receive cilostazol SR capsule (200-mg) a day (n = 30) or placebo (n = 30) on top of dual antiplatelet therapy (DAPT) with clopidogrel and aspirin. Before randomization (baseline) and at 30-day follow-up, circulating EPC levels were analyzed using flow cytometry and hemostatic measurements were evaluated by VerifyNow and thromboelastography assays. The primary endpoint was the relative change in EPC levels between baseline and 30-day. Results: At baseline, there were similar levels of EPC counts between treatments, whereas patients with cilostazol showed higher levels of EPC counts compared with placebo after 30 days. Cilostazol versus placebo treatment displayed significantly higher changes in EPC levels between baseline and follow-up (ΔCD133+/KDR+: difference 216%, 95% confidence interval (CI) 44~388%, p = 0.015; ΔCD34+/KDR+: difference 183%, 95% CI 25~342%, p = 0.024). At 30-day follow-up, platelet reactivity was lower in the cilostazol group compared with the placebo group (130 ± 45 versus 169 ± 62 P2Y12 Reaction Unit, p = 0.009). However, there were no significant correlations between the changes of EPC levels and platelet reactivity. Conclusion: Adjunctive cilostazol on top of clopidogrel and aspirin versus DAPT alone is associated with increased EPC mobilization and decreased platelet reactivity in AMI patients, suggesting its pleiotropic effects against atherothrombotic events (NCT04407312).

Impact of cardiac rehabilitation referral on one-year outcome after discharge of patients with acute myocardial infarction

2018 ◽  
Vol 26 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Matthias Hermann ◽  
Fabienne Witassek ◽  
Paul Erne ◽  
Hans Rickli ◽  
Dragana Radovanovic
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
St Elevation Myocardial Infarction ◽  
Multivariable Logistic Regression Analysis ◽  
St Elevation ◽  
One Year ◽  
Lost To Follow Up ◽  
The Impact

Background Cardiac rehabilitation after an acute myocardial infarction has a class I recommendation in the present guidelines. However, data about the impact on mortality in Switzerland are not available. Therefore, we analysed one-year outcome of acute myocardial infarction patients according to cardiac rehabilitation referral at discharge. Design and methods Data were extracted from the Swiss AMIS Plus registry and included patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, who were asked to give their informed consent to a telephone follow-up one year after discharge. Results From 10,141 patients, 1956 refused to participate in follow-up and 302 were lost to follow-up. There were 4508 (57.2%) patients with cardiac rehabilitation referrals compared with 3375 (42.8%) without. Patients referred to cardiac rehabilitation were younger (62.4 years vs. 68.8 years), more often male (77% vs. 70%), presented more often with ST-elevation myocardial infarction (63.5% vs. 52.1%) and, apart from smoking (44.0% vs. 34.9%), they had fewer risk factors, such as dyslipidaemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients referred to cardiac rehabilitation had a lower crude one-year all-cause mortality (1.7% vs. 5.8%; p < 0.001) and lower rates of re-infarction, rehospitalization for cardiovascular disease and intervention (all p < 0.005). In a multivariable logistic regression analysis, cardiac rehabilitation was an independent predictor for lower mortality rate (odds ratio 0.65; 95% confidence interval 0.48–0.89; p = 0.007). Conclusions Although the detailed data of cardiac rehabilitation programmes and patient participation were not available for this study, our data from 7883 acute myocardial infarction patients showed a better one-year outcome for patients with cardiac rehabilitation referrals than for those without.

scholarly journals Impact of smoke-free legislation on acute myocardial infarction and stroke mortality: Tianjin, China, 2007–2015

2019 ◽  
Vol 29 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Hong Xiao ◽  
Hui Zhang ◽  
Dezheng Wang ◽  
Chengfeng Shen ◽  
Zhongliang Xu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Large Scale ◽  
National Level ◽  
Interrupted Time Series ◽  
Stroke Mortality ◽  
Series Design ◽  
The Impact ◽  
Interrupted Time Series Design

BackgroundSmoke-free legislation is an effective way to protect the population from the harms of secondhand smoke and has been implemented in many countries. On 31 May 2012, Tianjin became one of the few cities in China to implement smoke-free legislation. We investigated the impact of smoke-free legislation on mortality due to acute myocardial infarction (AMI) and stroke in Tianjin.MethodsAn interrupted time series design adjusting for underlying secular trends, seasonal patterns, population size changes and meteorological factors was conducted to analyse the impact of the smoke-free law on the weekly mortality due to AMI and stroke. The study period was from 1 January 2007 to 31 December 2015, with a 3.5-year postlegislation follow-up.ResultsFollowing the implementation of the smoke-free law, there was a decline in the annual trends of AMI and stroke mortality. An incremental 16% (rate ratio (RR): 0.84; 95% CI: 0.83 to 0.85) decrease per year in AMI mortality and a 2% (RR: 0.98; 95% CI: 0.97 to 0.99) annual decrease in stroke mortality among the population aged ≥35 years in Tianjin was observed. Immediate postlegislation reductions in mortality were not statistically significant. An estimated 10 000 (22%) AMI deaths were prevented within 3.5 years of the implementation of the law.ConclusionThe smoke-free law in Tianjin was associated with reductions in AMI mortality. This study reinforces the need for large-scale, effective and comprehensive smoke-free laws at the national level in China.

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