Documentation of person-centred health plans for patients with acute coronary syndrome

2017 ◽  
Vol 17 (2) ◽  
pp. 114-122 ◽  
Author(s):  
Inger Jansson ◽  
Andreas Fors ◽  
Inger Ekman ◽  
Kerstin Ulin
Keyword(s):  
Social Support ◽  
Acute Coronary Syndrome ◽  
Social Relations ◽  
Social Life ◽  
Leisure Activities ◽  
Lifestyle Changes ◽  
University Hospital ◽  
Health Plans ◽  
Coronary Syndrome ◽  
Patient Goals

Background: Personalised care planning is argued for but there is a need to know more about what the plans actually contain. Aim: To describe the content of person-centred health, plans documented at three healthcare levels for patients with acute coronary syndrome. Design: Patients with acute coronary syndrome aged under 75 years and admitted to two coronary care units at a university hospital were enrolled in the study. This retrospective descriptive study documented 89 person-centred health plans at three healthcare levels: hospital, outpatient and primary care. In total, 267 health plans were reviewed and a quantitative content analysis conducted. The health plans included commonly formulated goals, patients’ own resources and support needed. Results: The health plan goals were divided into three categories: lifestyle changes, illness management and relational activities. The most frequently reported goal for better health was increased physical activity, followed by social life/leisure activities and return to paid professional work. In order to reach the goals, patients identified three ways: own resources, family and social support and healthcare system, in total three categories. The most frequently reported own capability was self-motivation. Spouses and children were important sources of family and social support. The most frequently reported healthcare support was cardiac rehabilitation. Conclusion: In traditional care and treatment plans devised by health professionals, patient goals often comprise behavioural changes. When patients identify their own goals and resources with the help of professionals, they include maintaining social relations and being able to return to important activities such as work.

P6440The perils of polyvascular disease with concomitant type 2 diabetes in a real-world cohort of patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Denegri ◽  
G Magnani ◽  
V A Rossi ◽  
L Raeber ◽  
S Windecker ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Acute Coronary Syndrome ◽  
Cause Of Death ◽  
Primary Endpoint ◽  
Real World ◽  
University Hospital ◽  
High Risk Population ◽  
Coronary Syndrome ◽  
Potential Marker

Abstract Background Despite substantial improvement in type 2 diabetes (DM2) care, the burden of recurrent cardiovascular (CV) events remains high. Polyvascular disease (PVD), has recently emerged as a potential marker of heightened residual ischemic risk in DM2 patients, that are likely to derive a greater absolute risk reduction from more intense, individualized therapy. Purpose We sought to assess the relationship between DM2, PVD and CV outcomes among 2,168 all-comers patients admitted to four Swiss University Hospital for acute coronary syndrome (ACS) and enrolled in the prospective multicenter SPUM registry (NCT 01000701). Methods PVD was defined as concomitant peripheral artery disease, stroke or transient ischemic attack, or both. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: Stroke, myocardial infarction, CV death). Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with PVD disease in DM2 and outcomes, and intention-to-treat analysis was performed. Results Out of 2,168 ACS patients, 396 patients (18.3%) had DM2; of these 62 (15%) had PVD. Despite compared with the general ACS population, those with PVD + DM2 were more likely to have a complex history of CV disease, such as previous MI (27.4% vs 14.7%, p=0.021), prior percutaneous (37.1% vs 17%, p<0.001) or surgical (24.2% vs 5.1%, p<0.001) coronary revascularization, one third was not on statin therapy. At 1 year, patients with PVD + DM2 had a higher rate of MACCE compared to those presenting with PVD or DM2 alone. Rates of the single components of the primary endpoint and all-cause of death were all significantly higher in patients with PVD + DM2 vs. PVD or DM2 alone (Fig. 1A, all p<0.001). This enhanced risk persisted after adjustment for significant baseline differences, with a 34% (Adj. HR 1.34, 95% CI 1.15–1.49, p=0.02) increase in MACCE and a 44% increment of all cause of death (Adj. HR 1.44, 95% CI 1.06–1.54, p=0.02, Fig. 1B). Outcomes by PVD and DM2 status. Conclusions Among a real-world cohort of ACS-patients, the coexistence of PVD and DM2 highlights the highest CV risk phenotype, being associated with significant increased rates of MACCE and all-cause of death. These observations might help clinicians to furtherly stratify the very high risk population and to identify patients who may derive the greatest benefit from more intense secondary prevention therapies.

scholarly journals Clinical impact of CREDO-kyoto risk score on in-hospital bleeding in patients with acute coronary syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Minematsu ◽  
M Natsuaki ◽  
G Yoshioka ◽  
K Shinzato ◽  
Y Nishimura ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Risk Score ◽  
Major Bleeding ◽  
Bleeding Risk ◽  
Risk Groups ◽  
University Hospital ◽  
Severe Bleeding ◽  
Bleeding Events ◽  
Coronary Syndrome

Abstract Background/Introduction CREDO-Kyoto bleeding risk score was developed to predict the post-discharge bleeding events in patients with percutaneous coronary intervention. However, there were limited reports of the effectiveness of this score to predict the in-hospital bleeding events in patients with acute coronary syndrome (ACS). Methods We evaluated 562 consecutive ACS patients in Saga university hospital between 2014 and 2019. Primary outcome was major bleeding during hospitalization. Major bleeding was defined as the GUSTO moderate/severe bleeding. Patients were classified into three groups according to the CREDO-Kyoto bleeding risk score (low, intermediate and high). Results Major bleeding events occurred in 12.1% of all patients during hospitalization. Patients in the high risk group (n=22) had significantly higher incidence of major bleeding than those in the intermediate (n=113) and the low risk groups (n=427) (22.7%, 18.6%, versus 9.8%, respectively, p=0.018, see figure). Multivariate analysis showed that intermediate and high risk groups were independent predictors for the in-hospital major bleeding. Conclusions CREDO-Kyoto risk score successfully identified high risk ACS patients for the major bleeding during hospitalization. FUNDunding Acknowledgement Type of funding sources: None. Results

scholarly journals 774 Young adults with acute coronary syndrome: still a long road ahead

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Jessica Ielapi ◽  
Salvatore De Rosa ◽  
Giuseppe Deietti ◽  
Claudia Critelli ◽  
Giuseppe Panuccio ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Young Adults ◽  
Myocardial Revascularization ◽  
Young Patients ◽  
Clinical Profile ◽  
University Hospital ◽  
Complete Revascularization ◽  
Percutaneous Coronary Angioplasty ◽  
Coronary Syndrome ◽  
Magna Graecia

Abstract Aims Acute coronary syndrome (ACS) are a leading cause for mortality and morbility worldwide. Despite ACS usually affects the older population, it also occurs in younger individuals. Young ACS patients (YACS) have a significantly worse prognosis compared to their age-mates in the general population. Despite YACS are characterized by a different risk profiles compared to their older mates, many aspects still remain elusive. Aim of this study was to describe the clinical profile of young adults with Acute Coronary Syndrome. Methods and results Young patients (≤50 years) with the first diagnose of Acute Coronary Syndrome admitted to the Magna Graecia University Hospital were enrolled in the ongoing GENEPAMY registry. Over 7 years, a total of 675 eligible patients with Acute Coronary Syndrome aged 44 ± 8 years were included. Men accounted for 84.9% of all patients. Overall, 11.9% of patients had diabetes, 69.1% hypertension, 17.6% obesity, 93.6% dyslipidemia, while 75.5% were smokers. In the overall cohort, 44.1% were first diagnosed with STEMI, 45.9% with NSTEMI, while the remaining had been admitted for Unstable Angina. Cardiogenic shock was present at admission in 2.7% of cases. Multivessel disease was present in 39% of cases and was significantly less frequent in women (P &lt; 0.001). Thrombolysis was administered as the initial treatment in 15.1% of cases but was ineffective in 66.7% of patients. Percutaneous coronary angioplasty was performed in 79.1% of patients, while 1.9% of patients underwent surgical myocardial revascularization. Spontaneous coronary dissection was present in 0.7% of men and 17.2% of women (P &lt; 0.001). At admission, 98.9% of patients had been treated with ASA, 17.9% with clopidogrel, 49.1% with ticagrelor and 28.4% with prasugrel. A complete revascularization was achieved in 81.6% during the index hospitalization but was significantly more frequent in women compared to men (86.3% vs. 80.8; P &lt; 0.001). Conclusions Our data highlight that YACS present a peculiar clinical profile. In particular, the high cardiovascular risk profile demands attention. Finally, despite most patients were men, young women with ACS present several relevant differences compared to men, needing a more careful clinical management.

scholarly journals Incidence and Pattern of Dysrhythmia in Acute Coronary Syndrome at Suez Canal University Hospital

2014 ◽  
Vol 17 (1) ◽  
pp. 50-63
Author(s):  
Moamin Alassouli ◽  
Ahmad El-hawary ◽  
Hanan Kamal ◽  
Hussein Mahmoud
Keyword(s):  
Acute Coronary Syndrome ◽  
Suez Canal ◽  
University Hospital ◽  
Coronary Syndrome

scholarly journals Impact of smoking cessation on depression after acute coronary syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Krasieva ◽  
C Clair ◽  
B Gencer ◽  
D Carballo ◽  
R Klingenberg ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Acute Coronary Syndrome ◽  
Smoking Status ◽  
Antidepressant Drug ◽  
Depression Scale ◽  
Lifestyle Changes ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Quit Smoking ◽  
One Year

Abstract Background Smoking and depression are two risk factors for acute coronary syndrome (ACS) that often go hand-in-hand, as smokers are more likely to be depressed and people that are depressed are more likely to be smokers. Smoking cessation in depressed patients with ACS may worsen depressive symptoms, which could increase the risk of recurrence of cardiac events and decrease adherence to other cardiac risk-reducing lifestyle changes. Purpose We aimed to investigate the evolution of depression according to smoking cessation one-year after ACS. Furthermore, we investigated if there was a higher incidence of one-year depression among ACS smokers who quit in comparison to continuous smokers. Method Data from 1,822 patients with ACS of the Swiss multicenter SPUM-ACS cohort study were analysed over a one-year follow-up period. Participants were classified in three groups based on smoking status one-year post-ACS – continuous smokers, smokers who quit within the year post-ACS, and non-smokers. Depression status at baseline and at one-year after the index ACS event was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A multivariate adjusted logistic regression model was used to calculate the risk ratio (RR) between groups. Results In comparison to depressed smokers who continued to smoke one year post-ACS, depressed smokers who quit smoking had an adjusted RR of 2.02 (95% CI 1.04–3.92) of improving their depression. Among 543 non-depressed ACS smokers, new depression at one-year was found in 57/266 (21.4%) smokers who quit, and 68/277 (24.6%) continuous smokers, with an adjusted RR of 0.89 (95% CI 0.58–1.36) of incidence of new depression. Conclusion Smokers with depression at the time of ACS who quit smoking improved more frequently their depression compared to those who continued smoking. Although not statistically significant, there was a smaller incidence of new depression among smokers who quit after ACS in comparison to continuous smokers. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

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