3333Contemporary mortality rates in myocardial infarction patients in Sweden: a tale of two registries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Siverskog ◽  
M Janzon ◽  
L.-Å Levin ◽  
J Alfredsson ◽  
M Henriksson
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Patient Characteristics ◽  
Primary Diagnosis ◽  
Age And Gender ◽  
Quality Registry ◽  
Mortality Outcome ◽  
Mortality Difference ◽  
And Gender ◽  
One Year

Abstract Background Sweden has contributed to the understanding of the long-term prognosis after myocardial infarction (MI) utilising the quality registry SWEDEHEART, including patients admitted to heart intensive care, and the National Patient Registry (PAR), based on administrative records for Swedish hospitals. As registration procedures differ between the registries, and not all MI patients are admitted to heart intensive care, MI patients identified in SWEDEHEART and PAR, respectively, will yield different cohorts of patients. This may result in different epidemiological research findings regarding prognosis after MI. Purpose To study MI populations identified in SWEDEHEART and PAR, respectively, and investigate potential differences in mortality outcome. Methods Patients hospitalised with an MI primary diagnosis (ICD-10 I21) between 2002 and 2015 were identified using SWEDEHEART and PAR. The analysis time started at the date of hospital admission and survivors were followed for 365 days. Kaplan-Meier analysis was used to estimate survival by cohort category controlling for age and gender. Results Excluding cases with invalid data (n=1,905), 225,612 and 282,118 SWEDEHEART and PAR patients, respectively, were identified. We found 213,367 patients in both SWEDEHEART and PAR, whereas 12,245 and 68,751 patients were unique to SWEDEHEART and PAR, respectively. The one-year survival probability after MI in the SWEDEHEART population was 0.841, compared to 0.788 in PAR (Figure). This discrepancy can be explained by high mortality among patients not covered by SWEDEHEART and persists after controlling for age and gender (Table). To what extent differences in registration procedures and other patient characteristics can explain the mortality difference is an area for further research. One-year survival by age and gender Age ± 1 year Male Female PAR S.H. Diff. PAR S.H. Diff. 65 0.922 0.936 0.015 0.919 0.936 0.017 70 0.893 0.909 0.016 0.889 0.908 0.019 75 0.829 0.858 0.029 0.834 0.860 0.026 80 0.743 0.783 0.040 0.768 0.800 0.033 85 0.625 0.677 0.052 0.662 0.705 0.042 One-year survival after MI Conclusion Estimated one-year survival for MI patients differs by up to 5 percentage points depending on the registry used. Although further research is needed to fully understand these differences, epidemiological findings regarding MI prognosis should be interpreted in light of registry type used and population represented. Acknowledgement/Funding Region Östergötland

scholarly journals Age and gender differences in medical adherence after myocardial infarction: Women do not receive optimal treatment – The Netherlands claims database

2017 ◽  
Vol 25 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Daniëlle C Eindhoven ◽  
Alexander D Hilt ◽  
Thomas C Zwaan ◽  
Martin J Schalij ◽  
C Jan Willem Borleffs
Keyword(s):  
Myocardial Infarction ◽  
Gender Differences ◽  
Medical Adherence ◽  
Age And Gender ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Age And Gender Differences ◽  
And Gender ◽  
One Year

Background Following myocardial infarction, medication is, besides lifestyle interventions, the cornerstone treatment to improve survival and minimize the occurrence of new cardiovascular events. Still, data on nationwide medication adherence are scarce. This study assesses medical adherence during one year following myocardial infarction, stratifying per type of infarct, age and gender. Design Retrospective cohort study. Methods In The Netherlands, all inhabitants are by law obliged to have health insurance and all claims data are centrally registered. In 2012 and 2013, all national diagnosis-codings of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were acquired. Furthermore, information on retrieved medication was extracted from the Dutch Pharmacy Information System. Twelve months after discharge, the retrieved medication at the pharmacy of each pharmacological therapy (aspirin-species, P2Y12-inhibitor, statin, beta-blocker, angiotensin-converting enzyme-/angiotensin 2-inhibitor, vitamin-K antagonists or novel oral anticoagulant) were analysed. Results In total, 59,534 patients (67 ± 13 years, 39,545 (66%) male, 57% NSTEMI) were included, of whom 52,672 (88%) patients were analysed for one-year medical adherence. STEMI patients more often achieved optimal medical adherence than NSTEMI patients (60% vs. 40%, p ≤ 0.001). In both STEMI and NSTEMI, use of all five indicated drugs was higher in male patients compared with female (STEMI male 61% vs. female 57%, p ≤ 0.001; NSTEMI male 43% vs. female 37%, p ≤ 0.001. With increasing age, a gradual decrease was observed in the use of aspirin, P2Y12-inhibitors and statins. Conclusion Age and gender differences existed in medical adherence after myocardial infarction. Medical adherence was lower in women, young patients and elderly patients, specifically in NSTEMI patients.

scholarly journals CAUSES FOR EXTRACTION OF PERMANENT TEETH IN GENERAL DENTAL PRACTICES IN YEMEN

2019 ◽  
Author(s):  
Yahya Alhadi ◽  
Abubakr H Rassem ◽  
Hassan Abdulwahab Al-Shamahy ◽  
Khaled M Al-Ghaffari
Keyword(s):  
Dental Caries ◽  
Tooth Extraction ◽  
Patient Characteristics ◽  
T Test ◽  
Permanent Teeth ◽  
Age And Gender ◽  
Dental Clinics ◽  
Dental Practices ◽  
And Gender ◽  
One Year

The aim of this survey was to investigate the primary causes for extraction of permanent teeth, its correlations with age and gender, as well as identify the important predictors for dental caries in Sana'a University dental clinics in Sana'a city, Yemen. The study was conducted over a period of one year; its population consisted of 1,420 patients, aged 9–72 years, who underwent tooth extraction. There were 761(53.6%) male and 659 (46.4%) female patients. The frequency distribution was calculated using the t-test, ANOVA and t test for differences in mean number of extracted teeth and the logistic regression model to evaluate the variables associated with causes for tooth extraction. A total of 2,585 teeth were extracted from the 1,420 patients. The highest rate (23.1%) of extraction occurred for those 41–50 years old. Males comprised 53.6% of patients but had more teeth (1598, 61.8%) extracted than females (987, 38.2%).The rate of teeth extracted on the day of the survey per patient was 1.82±0.07 (2.1±0.1 in males and 1.5±0.05 in females). Tooth loss due to caries was 69%; periodontal disease was 28%; pre-prosthetic reasons were 1.9% and other reasons were 1.14%. There was a significant association between patient characteristics (age and gender) and number of teeth extracted in which the Mean±SD of extracted numbers were increase with increasing age and higher in male patients than in females (p<0.001). The most frequently extracted teeth were mandibular first and second molars (446, 17.3%), followed by maxillary premolars (415, 16.1%), while mandibular canines were least frequently extracted (87, 3.4%). In conclusion; dental caries and periodontal problems were the main causes for tooth extraction in Sana'a city, Yemen.  

P3614Impact of renal dysfunction in patients with acute myocardial infarction on early management and outcome: a first observational French study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Bernard ◽  
C El Khoury ◽  
L Fraticelli
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Hospital Mortality ◽  
Real Life ◽  
Patient Characteristics ◽  
Hospital Treatment ◽  
Kidney Dysfunction ◽  
Early Management ◽  
St Segment Elevation ◽  
One Year

Abstract Background Kidney dysfunction (KD) is largely associated to cardiovascular mortality. Purpose Analyse early management and outcome in real life of ST segment elevation myocardial infarction (STEMI) patients with KD compared to STEMI patients with normal renal function. Methods Using 10 years' data from OSCAR regional registry, we investigated the early management and outcome of all patients with STEMI. Kidney dysfunction (KD) has been defined by creatinine clearance (CrCl) <90mL/min and was assessed using Cockcroft-Gault (CG) equation. Among them, two groups were identified: patients with normal kidney function (NKF) (CrCl ≥90mL/min) and patients with KD (CrCl <90mL/min). KD patients were stratified into 3 groups: patients with mild KD (CrCl 60–90mL/min), patients with moderate KD (CrCl 30–60mL/min) and patients with severe KD (CrCl <30mL/min). The comparison of the groups concerned patient characteristics, therapeutic strategy and follow-up at 1, 6 and 12 months. Results Our study included 8 003 STEMI patients from 2009 to 2018, 4 234 (52.9%) of them with KD. Among these, 2441 (57.6%) patients had mild KD, 1494 (35.3%) moderate KD and 299 (7.1%) severe KD. NKF patients were younger than KD group (54 [48–61] vs 72 [63–81]). KD patients had more cardiovascular risk factors such as diabetes, hypertension and personal history of coronary disease (p<0.001), but were less smokers (p<0,001). KD patients presented less often chest pain, and more dyspnea or cardiac arrest (p<0,001). There was no difference in symptom-first medical contact delay (p=0.30). More than 14% of patients with KD presented with Killip≥2. In the KD group location of infarction was more often anterior and lateral. In-hospital treatment differed among the groups: KD patients received less prasugrel (11% vs 20%), ticagrelor (44% vs 49%), enoxaparin (70% vs 80%), morphine (29% vs 39%) or other analgesic (30% vs 35%), but more clopidogrel (33% vs 23%), diuretics (3% vs 0,7%) and catecholamines (5% vs 2%) (p<0.001). In-hospital mortality was higher in the KD group (9% vs 1%, p<0.001). One-year mortality was 14% in the KD group compared to 2% for patients with NKF (p<0.001). Also, in-hospital mortality was increasing exponentially with KD severity (2%, 8% and 24% for mild, moderate and severe KD) (p<0,001) as well as 1-year mortality (respectively 1%, 6% and 12% after 1 year) (p<0,001). Conclusion Kidney insufficiency is an independent risk factor for death in patients after myocardial infarction and was associated with poor prognosis at short- and long-term. We observed that mortality increased with KD severity. Despite a high cardiovascular risk, KD patients presenting STEMI are less likely to receive therapy, while having more co-morbidities and extended infarction. To achieve an optimal medical care of KD patients with STEMI, we should introduce evidence-based therapies in the acute phase.

scholarly journals Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients – real-world data from the Acute Coronary Syndrome Israeli Survey

2017 ◽  
Vol 7 (6) ◽  
pp. 497-503 ◽  
Author(s):  
Edward Koifman ◽  
Roy Beigel ◽  
Zaza Iakobishvili ◽  
Nir Shlomo ◽  
Yitschak Biton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Odds Ratio ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
Mobile Intensive Care Unit ◽  
St Elevation ◽  
Mobile Intensive Care Units ◽  
One Year

Background: Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Methods: Data from the Acute Coronary Survey in Israel registry 2000–2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. Results: The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120–262) vs 195 (interquartile range 130–333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66–0.94), p=0.01). Conclusions: Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

Increased Documentation and Management of Pediatric Obesity Following Implementation of an EMR Upgrade and Education

2011 ◽  
Vol 51 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Jennifer Keehbauch ◽  
Gretchen San Miguel ◽  
Leslie Drapiza ◽  
Julie Pepe ◽  
Richard Bogue ◽  
...  
Keyword(s):  
Clinical Management ◽  
Rate Of Change ◽  
Physician Education ◽  
Overweight Children ◽  
Age And Gender ◽  
Training And Education ◽  
Medicine Resident ◽  
Before And After ◽  
And Gender ◽  
One Year

Background: Overweight children are often not identified or counseled. Purpose: We assessed the documentation rate and clinical management of overweight children before and after an electronic medical record (EMR) upgrade calculating body mass index (BMI) percentile for age and gender. Methods: Family Medicine resident and faculty physicians at two sites received an EMR upgrade; Site1 physicians also received BMI training and education. From two years before to one year after the upgrade, randomly selected charts were reviewed for all encounters with overweight children for documentation of obesity and clinical management. Results: After the EMR upgrade, documentation and counseling rates significantly improved at both sites but the rate of change was greater for Site 1; postintervention documentation was significantly greater for Site 1 vs. Site 2 (40% vs. 28%, P<0.01). Conclusions: We found an increase in documentation and management of overweight children following an EMR upgrade that calculates BMI percentiles for age and gender. Physician education was an important adjunct.

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