P47 The impact of comorbid ischaemic heart disease on exercise capacity in COPD patients

ObjectivesTo compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD).DesignCohort study linking morbidity, mortality and medication data from Swedish national registries.ParticipantsFirst-time users of GLD during 2007–2016.OutcomesPredicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled.Results260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD—prior MI and 22 550 (9%) had IHD+MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (±prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (<60 years) patients had a relative greater risk compared with older patients.ConclusionsT2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.

Download Full-text

Comorbidity phenotypes and risk of mortality in patients with ischaemic heart disease in the UK

Heart ◽

10.1136/heartjnl-2019-316091 ◽

2020 ◽

Vol 106 (11) ◽

pp. 810-816 ◽

Cited By ~ 3

Author(s):

Francesca Crowe ◽

Dawit T Zemedikun ◽

Kelvin Okoth ◽

Nicola Jaime Adderley ◽

Gavin Rudge ◽

...

Keyword(s):

Heart Disease ◽

Latent Class Analysis ◽

Ischaemic Heart Disease ◽

Latent Class ◽

Health Improvement ◽

Class Analysis ◽

Musculoskeletal Conditions ◽

Risk Of Mortality ◽

The Uk ◽

The Impact

ObjectivesThe objective of this study is to use latent class analysis of up to 20 comorbidities in patients with a diagnosis of ischaemic heart disease (IHD) to identify clusters of comorbidities and to examine the associations between these clusters and mortality.MethodsLongitudinal analysis of electronic health records in the health improvement network (THIN), a UK primary care database including 92 186 men and women aged ≥18 years with IHD and a median of 2 (IQR 1–3) comorbidities.ResultsLatent class analysis revealed five clusters with half categorised as a low-burden comorbidity group. After a median follow-up of 3.2 (IQR 1.4–5.8) years, 17 645 patients died. Compared with the low-burden comorbidity group, two groups of patients with a high-burden of comorbidities had the highest adjusted HR for mortality: those with vascular and musculoskeletal conditions, HR 2.38 (95% CI 2.28 to 2.49) and those with respiratory and musculoskeletal conditions, HR 2.62 (95% CI 2.45 to 2.79). Hazards of mortality in two other groups of patients characterised by cardiometabolic and mental health comorbidities were also higher than the low-burden comorbidity group; HR 1.46 (95% CI 1.39 to 1.52) and 1.55 (95% CI 1.46 to 1.64), respectively.ConclusionsThis analysis has identified five distinct comorbidity clusters in patients with IHD that were differentially associated with risk of mortality. These analyses should be replicated in other large datasets, and this may help shape the development of future interventions or health services that take into account the impact of these comorbidity clusters.

Download Full-text

Diagnosis and assessment of stroke

10.1093/med/9780199600830.003.0235 ◽

2016 ◽

Author(s):

Candice Delcourt ◽

Craig Anderson

Keyword(s):

Heart Disease ◽

Ischaemic Stroke ◽

Ischaemic Heart Disease ◽

Cause Of Death ◽

Physical Disability ◽

Early Phase ◽

Haemorrhagic Stroke ◽

Common Cause ◽

The World ◽

The Impact

Approximately 20 million strokes occur in the world each year and over one-quarter of these are fatal. This makes stroke the second most common cause of death, after ischaemic heart disease, and strokes are responsible for 6 million deaths (almost 10% of all deaths) annually. Stroke has major consequences in terms of residual physical disability, depression, dementia, epilepsy, and carer burden. Moreover, around 20% of survivors experience a further stroke or serious vascular event within a few years of the index event. Ischaemic stroke contributes the greatest share of the impact of stroke, with a rate of approximately 1 in 1000 person-years and accounting for between 60% (in Asia) and 90% (in Western ‘white’ populations) of all strokes around the world. Diagnosis and assessment are essentially clinical and confirmed by CT or MRI scanning. Prognostication is difficult in the early phase of haemorrhagic stroke and in ischaemic stroke is affected by the availability and timely use of treatments to recanalize the occluded vessel.

Download Full-text

Disparities experienced by Aboriginal compared to non-Aboriginal metropolitan Western Australians in receiving coronary angiography following acute ischaemic heart disease: the impact of age and comorbidities

International Journal for Equity in Health ◽

10.1186/s12939-014-0093-3 ◽

2014 ◽

Vol 13 (1) ◽

Cited By ~ 6

Author(s):

Derrick Lopez ◽

Judith M Katzenellenbogen ◽

Frank M Sanfilippo ◽

John A Woods ◽

Michael S T Hobbs ◽

...

Keyword(s):

Heart Disease ◽

Coronary Angiography ◽

Ischaemic Heart Disease ◽

The Impact

Download Full-text

11 The impact of cardiac magnetic resonance viability assessment on the management of patients with ischaemic heart disease and left ventricular dysfunction: Abstract 11 Table 1

Heart ◽

10.1136/heartjnl-2015-307845.11 ◽

2015 ◽

Vol 101 (Suppl 2) ◽

pp. A6-A6

Author(s):

BR Cole ◽

H Douglas ◽

CM Soong ◽

P Horan ◽

LJ Dixon ◽

...

Keyword(s):

Heart Disease ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ischaemic Heart Disease ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Viability Assessment ◽

The Impact

Download Full-text

mHealth interventions in the management of heart failure, ischaemic heart disease and hypertension: a systematic review and meta-analysis of randomised controlled trials

European Heart Journal ◽

10.1093/ehjci/ehaa946.3507 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Indraratna ◽

D Tardo ◽

J Yu ◽

K Delbaere ◽

M Brodie ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Meta Analysis ◽

Funding Source ◽

Smartphone Applications ◽

Coronary Syndrome ◽

Significant Difference ◽

The Impact

Abstract Introduction Cardiovascular disease (CVD) remains the leading cause of death in the world. Mobile phones have become ubiquitous in most developed societies. Smartphone applications, telemonitoring and clinician-driven short message service (SMS) allow for novel methods in managing chronic cardiovascular conditions such as ischaemic heart disease, heart failure and hypertension. Purpose To evaluate the impact of mobile phone-based interventions (MPIs) on mortality, hospitalisations and blood pressure and body mass index (BMI) in patients diagnosed with either acute coronary syndrome, heart failure or hypertension. Methods A systematic review was conducted using seven electronic databases, identifying all randomised control trials (RCTs) featuring an MPI in the management of these conditions. Meta-analysis was performed by using standard analytical techniques. The odds ratio (OR) was used as a summary statistic. Results Twenty-six RCTs including 6,713 patients were identified. Of these 26 studies, 13 examined text messaging intereventions, 10 studied telemonitoring interventions and three described smartphone applications with other functions. Twelve studies were included for meta-analysis. In patients with heart failure (n=1683), MPIs were associated with a significantly lower rate of all-cause hospital admissions at six months (31% vs. 36%, OR 0.77, 95% CI 0.62–0.97, p=0.03, I2 = 0). A significant difference was also demonstrated for heart-failure admissions (14.0% vs. 18.5%, OR 0.69, 95% CI 0.48 to 0.98, p=0.04, I2 = 26%). There was no difference in mortality (10.4% vs. 11.6% p=0.45). In patients with hypertension, the difference in systolic BP was 4.3mmHg less in the intervention group (95% CI: −7.8 to −0.78 mmHg, p=0.02). Four studies examined medication compliance as an endpoint in patients with ischaemic heart disease, and all four demonstrated a significant difference favouring the MPI group (see table 1). However, due to variable quantification of compliance, meta-analysis was not possible. There was no significant difference in the change in BMI from four studies after six or more months (mean difference −0.46, 95% CI: −1.44 to 0.52, P=0.36). Conclusions The available data suggests MPIs may have a role as valuable adjuncts in the management of chronic CVD. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council (NHMRC)

Download Full-text

The impact of the variation in death certification and coding practices on trends in mortality from ischaemic heart disease

Australian Health Review ◽

10.1071/ah020189a ◽

2002 ◽

Vol 25 (4) ◽

pp. 189 ◽

Cited By ~ 12

Author(s):

Linping Chen ◽

Sue Walker ◽

Shilu Tong

Keyword(s):

Heart Disease ◽

Ischaemic Heart Disease ◽

Death Certificates ◽

Death Certification ◽

Mortality Trends ◽

Factors Affecting ◽

Icd Codes ◽

The Impact

This review examines the literature relating to the effect of death certification practices, coding and the terminology used by certifiers on trends in mortality from ischaemic heart disease (IHD). The review identifies factors that affect mortality trends in a number of countries and discusses methods for assessing the impact of these issues on trends in mortality from IHD. The review found that although the magnitude of the effects of the issues on trends in mortality from ischaemic heart disease varied among countries and sub-populations, miscertification and the resultant assignment of misleading ICD codes, particularly for ill-defined cardiovascular conditions, were important factors affecting the IHD mortality trends. In light of these findings, it is essential to monitor regularly the accuracy of death certificates for IHD and consider necessary adjustments in analysing mortality trends from IHD.

Download Full-text