scholarly journals Acute myocardial infarction incidence and survival in Aboriginal and non-Aboriginal populations: an observational study in the Northern Territory of Australia, 1992–2014

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036979
Author(s):  
Cushla Coffey ◽  
Yuejen Zhao ◽  
John R Condon ◽  
Shu Li ◽  
Steven Guthridge
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Aboriginal People ◽  
Age Groups ◽  
Northern Territory ◽  
Older Age ◽  
Aboriginal Population ◽  
Aboriginal Populations ◽  
National Trends ◽  
Over Time

ObjectivesTo examine long-term trends in acute myocardial infarction (AMI) incidence and survival among Aboriginal and non-Aboriginal people.DesignRetrospective cohort study.Setting, participantsAll first AMI hospital cases and deaths due to ischaemic heart disease in the Northern Territory of Australia (NT), 1992–2014.Main outcome measuresAge standardised incidence, survival and mortality.ResultsThe upward trend in Aboriginal AMI incidence plateaued around 2007 for males and 2001 for females. AMI incidence decreased for non-Aboriginal population, consistent with the national trends. AMI incidence was higher and survival lower for males, for Aboriginal people and in older age groups. In 2014, the age standardised incidence was 881 and 579 per 100 000 for Aboriginal males and females, respectively, compared with 290 and 187 per 100 000 for non-Aboriginal counterparts. The incidence disparity between Aboriginal and non-Aboriginal population was much greater in younger than older age groups. Survival after an AMI improved over time, and more so for Aboriginal than non-Aboriginal patients, because of a decrease in prehospital deaths and improved survival of hospitalised cases.ConclusionsThere was an important breakpoint in increasing trends of Aboriginal AMI incidence between 2001 and 2007. The disparity in AMI survival between the NT Aboriginal and non-Aboriginal populations reduced over time as survival improved for both populations.

scholarly journals Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

2020 ◽  
Vol 9 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Mattias Skielta ◽  
Lars Söderström ◽  
Solbritt Rantapää-Dahlqvist ◽  
Solveig W Jonsson ◽  
Thomas Mooe
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Congestive Heart Failure ◽  
Cox Regression Analysis ◽  
Co Morbidity ◽  
One Year ◽  
Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

scholarly journals Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
André Åström ◽  
Lars Söderström ◽  
Thomas Mooe
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Incidence Rates ◽  
P2y12 Inhibitors ◽  
Over Time

AbstractOnly sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.

Abstract P274: Physical Activity Patterns and Determinants Following Acute Myocardial Infarction: Insights From the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients)

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Karl E Minges ◽  
Kelly M Strait ◽  
Sarah Camhi ◽  
Judith H Lichtman ◽  
Rachel P Dreyer ◽  
...  
Keyword(s):  
Physical Activity ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Activity Patterns ◽  
Estimating Equation ◽  
Vigorous Activity ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Wide Range ◽  
Over Time

Introduction: Despite the benefits of participation in regular physical activity (PA) following acute myocardial infarction (AMI), little is known about the habitual patterns of PA for young AMI patients, especially expanding beyond findings for those engaged in cardiac rehabilitation. We assessed patterns and determinants in levels of PA over a period of 12-months following AMI. Methods: A 2:1 (women:men) observational study design enrolled 3,572 AMI patients (2,397 women, 67.1%) aged 18-55 years from 103 US, 24 Spanish, and 3 Australian hospitals (2008-2012). Data were obtained by medical record abstraction and patient interviews at baseline (pre-AMI), 1- and 12-months post-AMI. Patients were assigned to AHA defined levels of PA based on self-reported frequency, duration, and intensity, as follows: Active (≥ 150 min/wk moderate or ≥ 75 min/wk vigorous activity), Insufficient (10-149 min/wk moderate or 10-74 min/wk vigorous activity), or Inactive (< 10 min/wk moderate or vigorous activity). We used a generalized estimating equation model to examine the factors associated with insufficient/inactive PA levels over time. Results: At baseline, 1- and 12-months post-AMI, 36.7%, 37.6%, and 40.0% of patients were considered active. There were 27 PA patterns observed from baseline to 12-months (Table). The most frequent were those with no change in PA over time (14% staying active, 7% insufficient, and 13% inactive). Additionally, 25% of patients had an increase (at least a one category change) in PA, while 19% had a decrease between baseline and 12-months post-AMI. Female sex, non-white race, non-active workplaces, smoking, diabetes, hypertension, and obesity were independently associated with being insufficient/inactive over time (all p<.05). Conclusions: Despite clinical recommendations, young adults recovering from AMI experience a wide range of PA patterns. By identifying factors associated with insufficient/inactive PA during recovery, targeted interventions can be introduced prior to hospital discharge.

Sharing the tracks to good tucker: identifying the benefits and challenges of implementing community food programs for Aboriginal communities in Victoria

2014 ◽  
Vol 20 (4) ◽  
pp. 373 ◽  
Author(s):  
Margaret Murray ◽  
Emily Bonnell ◽  
Sharon Thorpe ◽  
Jennifer Browne ◽  
Liza Barbour ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Aboriginal People ◽  
Key Factors ◽  
Aboriginal Population ◽  
Individual Level ◽  
Aboriginal Populations ◽  
Semistructured Interviews ◽  
Food Programs ◽  
Development Approach

Food insecurity is a significant issue in the Victorian Aboriginal population, contributing to the health disparity and reduced life expectancy. Community food programs are a strategy used to minimise individual level food insecurity, with little evidence regarding their effectiveness for Aboriginal populations. The aim of this study was to explore the role of community food programs operating for Aboriginal people in Victoria and their perceived influence on food access and nutrition. Semistructured interviews were conducted with staff (n = 23) from a purposive sample of 18 community food programs across Victoria. Interviews explored the programs’ operation, key benefits to the community, challenges and recommendations for setting up a successful community food program. Results were analysed using a qualitative thematic approach and revealed three main themes regarding key factors for the success of community food programs: (1) community food programs for Aboriginal people should support access to safe, affordable, nutritious food in a socially and culturally acceptable environment; (2) a community development approach is essential for program sustainability; and (3) there is a need to build the capacity of community food programs as part of a strategy to ensure sustainability. Community food programs may be an effective initiative for reducing food insecurity in the Victorian Aboriginal population.

scholarly journals Critical Illness and its Impact on the Aboriginal People of the Top End of the Northern Territory, Australia

2003 ◽  
Vol 31 (3) ◽  
pp. 294-299 ◽  
Author(s):  
D. Stephens
Keyword(s):  
Critical Illness ◽  
Aboriginal People ◽  
Survival Rates ◽  
Severity Of Illness ◽  
Northern Territory ◽  
Hospital Environment ◽  
Remote Communities ◽  
Aboriginal Population ◽  
Aboriginal Patient ◽  
Chronic Health Problems

The Royal Darwin Hospital (RDH) services a relatively large and geographically remote Aboriginal population who account for 45% of intensive care unit admissions. Critical illness in the Aboriginal population is different from the non-Aboriginal population of the “Top End” of the Northern Territory. The critically ill Aboriginal patient is younger, has more chronic health problems and a higher severity of illness at presentation. The city and the hospital environment are foreign to many Aboriginal patients retrieved from remote communities and this adds to the stress of the critical illness. English is a second, third or fourth language for many Aboriginal people from remote communities and strategies must be put in place to ensure informed consent and effective communication are achieved. Despite the increased severity of illness and complexity, the Royal Darwin Hospital ICU achieves the same survival rates for both Aboriginal and non-Aboriginal patients.

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