scholarly journals Effect of cardiac rehabilitation on 24-month all-cause hospital readmissions: A prospective cohort study

2018 ◽  
Vol 18 (3) ◽  
pp. 234-244 ◽  
Author(s):  
Emma Thomas ◽  
Mojtaba Lotfaliany ◽  
Sherry L Grace ◽  
Brian Oldenburg ◽  
C Barr Taylor ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Length Of Stay ◽  
Cardiac Rehabilitation ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
P Value ◽  
Post Discharge ◽  
Coronary Syndrome

Background: Ageing populations and increasing survival following acute coronary syndrome has resulted in large numbers of people living with cardiovascular disease and at high risk of hospitalizations. Rising hospital admissions have a significant financial cost to the healthcare system. Aim: The purpose of this study was to determine whether cardiac rehabilitation is protective against long-term hospital readmission (frequency and length) following acute coronary syndrome. Methods: Data from 416 Australian patients with acute coronary syndrome enrolled in the Anxiety Depression and heart rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) prospective cohort study between January 2013–June 2014 was analyzed secondarily. Participants self-reported cardiac rehabilitation attendance over the 12 months post-discharge. All-cause readmission data were extracted from hospital records 24 months post-index event. The association between cardiac rehabilitation and all-cause readmission, frequency of readmissions, and length of stay was assessed using three methods (a) regression analysis, (b) propensity score matching, and (c) inverse probability treatment weighting. Results: Overall, 416 patients consented (53% of eligible patients), of which 414 (99.5%) survived the first 30 days post-discharge and were included in the analysis. Medical records were located for 409 participants after 24 months (98% follow-up rate). In total, 267 (65%) reported attending cardiac rehabilitation; there were 392 readmissions by 239 patients. Cardiac rehabilitation attendance was not associated with all-cause hospital readmission; however, it was associated with lower frequency of hospital admissions (odds ratio 0.53, 95% confidence interval: 0.31–0.91 p-value:0.022) and length of stay (coefficient –1.21 days, 95% confidence interval: –2.46–0.26; marginally significant p-value: 0.055) in adjusted models. Conclusion: This study substantiates the long-term benefits of cardiac rehabilitation on readmissions, including length of stay, which would result in lower costs to the healthcare system.

Abstract 320: Healthcare Resource Utilization Among Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention and Using Prasugrel or Ticagrelor: A Retrospective Database Analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Cliff Molife ◽  
Mark B Effron ◽  
Mitch DeKoven ◽  
Swapna Karkare ◽  
Feride Frech-Tamas ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Coronary Intervention ◽  
Healthcare Resource Utilization ◽  
P Value ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To show that prasugrel (pras) was non-inferior to ticagrelor (ticag) in terms of healthcare resource utilization (HCRU) based upon 30- and 90-day all-cause rehospitalization rates among patients (pts) with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI). Methods: This retrospective study used anonymized hospital data from the IMS Patient-Centric Data Warehouse to identify ACS-PCI pts aged ≥18 years with ≥1 in-hospital claim for pras or ticag between 8/1/11-4/30/13. Three cohorts were predefined and analyzed: ACS-PCI (primary cohort), ACS-PCI without prior TIA or stroke (label cohort), and ACS-PCI pts without prior TIA or stroke and if age ≥75 years required evidence of diabetes or prior MI (core cohort). The McNemar’s test was used to evaluate adjusted outcome differences between propensity matched (PM) groups. P-value for non-inferiority (p-NI) test was obtained through a one-sided Z test by comparing log (RR) with log(1.2), a predefined margin. Results: Among 16,098 eligible pts, 13,134 (82%) received pras and 2,964 (18%) received ticag. Compared to ticag pts, pras pts were younger, more likely men, and less likely to have cardiovascular or bleeding risk factors (P<0.05). Of the total population, 1,375 (8.54%) and 2,374 (14.75%) were rehospitalized for any reason within 30 and 90 days post discharge, respectively. After PM adjustment, pras was non-inferior to ticag for 30- and 90-day all-cause rehospitalization rates in all 3 cohorts (p-NI < 0.01). Data are summarized in Table 1. All-cause rehospitalization for the label and core cohorts showed non-inferiority and a significantly lower 90-day rehospitalization rate with pras compared with ticag (Table). Conclusions: All-cause rehospitalizations at 30-and 90-days post discharge in ACS-PCI pts were non-inferior with pras vs. ticag in all 3 cohorts. Pras was associated with significantly lower risk for 90-day all-cause rehospitalizations compared with ticag in the label and core cohorts, which are the majority of pts receiving pras. Although there appears to be inherent bias and unmeasured confounders related to use of pras vs. ticag, these data show reductions in HCRU with pras compared with ticag in the real-world setting at 30- and 90-days post-discharge.

Acute coronary syndrome and long-term exposure to air pollution: a cohort study

2011 ◽  
Vol 2011 (1) ◽  
Author(s):  
Zorana J. Andersen ◽  
Sara Ø Brebbia ◽  
Klaus Kaae Andersen ◽  
Martin Hvidberg ◽  
Steen S. Jensen ◽  
...  
Keyword(s):  
Air Pollution ◽  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Coronary Syndrome

scholarly journals Orthopaedic corticosteroid injections and risk of acute coronary syndrome: a cohort study

2020 ◽  
pp. bjgp20X713945
Author(s):  
Katharine Thomas ◽  
Yochai Schonmann
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Hospital Admission ◽  
Cardiovascular Risk Factors ◽  
Hospital Admissions ◽  
Musculoskeletal Conditions ◽  
Coronary Syndrome ◽  
Corticosteroid Injections

BackgroundCorticosteroid injections (CSIs) are a common treatment for arthritis and other musculoskeletal conditions.AimTo determine whether there is an increased incidence of acute coronary syndrome (ACS) following intra-articular and soft-tissue CSI.Design and settingCohort study in an urban primary care orthopaedic clinic.MethodData were reviewed from all patients aged ≥50 years and seen by orthopaedic specialists between April 2012 and December 2015, including CSI, hospital admission in the week following the orthopaedic visit, and cardiovascular risk factors. The incidence of an ACS-associated hospital admission was compared between visits in which patients received CSIs and visits in which patients did not.ResultsA total of 60 856 orthopaedic visits were reviewed (22 131 individual patients). The mean age was 70.9 years (standard deviation [SD] = 10.8), and 66.5% were female. Injections were administered in 3068 visits (5.1%). In the week following the visit there were 25 ACS hospital admissions (41 per 100 000 visits); seven events were after visits with an injection, and 18 were after non-injection visits. Patients who had received an injection were more likely to experience a subsequent ACS. (227 versus 31 events per 100 000 visits, odds ratio [OR] = 7.3; 95% confidence interval [CI] = 2.8 to 19.1). The association between receiving a CSI and ACS remained similar when the analysis was restricted to subgroups defined by age, sex, and cardiovascular risk factors.ConclusionCSI for musculoskeletal conditions may substantially increase the risk of ACS in the week following the injection. Although the absolute risk of ACS is small, the effect size appears to be clinically significant.

scholarly journals Long-term Prognostic Value of Homocysteine in Patients with Acute Coronary Syndrome Complicated with Hypertension: A Multicenter Retrospective Study

2021 ◽  
Author(s):  
Qiang Chen ◽  
Xunshi Ding ◽  
Caiyan Cui ◽  
Tao Ye ◽  
Lin Cai
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Prognostic Value ◽  
Cox Regression ◽  
P Value ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Kaplan Meier

Abstract Background and aims: This study investigates the long-term prognostic value of homocysteine in patients with acute coronary syndrome complicated with hypertension. Methods:The current work is a multicenter, retrospective, observational cohort study. We consecutively enrolled 1288 ACS patients hospitalized in 11 general hospitals in Chengdu, China, from June 2015 to December 2019. The patients were divided into hypertension and non-hypertension groups, and each was further classified into hyperhomocysteinemia (H-Hcy) and normal homocysteinemia (N-Hcy) groups according to the cut-off value of homocysteine predicting long-term mortality during follow-up. In both groups, we used Kaplan-Meier and multivariate Cox regression analysis to assess the relationship between homocysteine and long-term prognosis. Results: The median follow-up time was 18 months (range: 13.83-22.37). During this period, 78 (6.05%) death cases were recorded. The hypertension was further divided into H-Hcy (n=245) and N-Hcy (n=543), with an optimal cut-off value of 16.81 µmol/L. Similarly, non-hypertension was further divided into H-Hcy (n=200) and N-Hcy (n=300), with an optimal cut-off value of 14 µmol/L. Kaplan-Meier survival curves revealed that H-Hcy had a significantly lower survival probability than N-Hcy, both in hypertension and non-hypertension (P-value<0.01). After adjusting for confounding factors, multivariate Cox regression analysis revealed that H-Hcy (HR=2.1923, 95% CI: 1.213-3.9625, P＜0.01) was an independent predictor of long-term all-cause death in ACS with hypertension, but not in non-hypertension.Conclusion: Elevated homocysteine level predicts risk of all-cause mortality in ACS with hypertension, but not in those without hypertension. it should be considered when determining risk stratification for ACS, particularly those complicating hypertension.

Long-term risk of acute coronary syndrome in patients with cholangitis: A 13-year nationwide cohort study

2014 ◽  
Vol 25 (5) ◽  
pp. 444-448 ◽  
Author(s):  
Ming-Shian Tsai ◽  
Yu-Fen Li ◽  
Cheng-Li Lin ◽  
Yao-Chun Hsu ◽  
Po-Huang Lee ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Coronary Syndrome

scholarly journals The adherence of doctors to clinical guidelines for the management of patients with acute coronary syndrome.

2018 ◽  
Vol 96 (7) ◽  
pp. 633-640
Author(s):  
A. I. Akhmetova ◽  
E. B. Kleymenova ◽  
G. I. Nazarenko ◽  
L. P. Yashina
Keyword(s):  
Acute Coronary Syndrome ◽  
Length Of Stay ◽  
Clinical Guidelines ◽  
Healthcare Costs ◽  
Routine Practice ◽  
Evidence Based ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Factors Influencing ◽  
St Elevation

In the management of acute coronary syndrome (ACS) adherence to evidence-based clinical guidelines (CG) improves outcomes and reduces healthcare costs. However, in routine practice compliance with CG is often insufficient. The aim of the study was to assess the association of adherence to CG with the length of stay and outcomes ofACS treatment, as well as to identify factors influencing the CG compliance. The study included 464 patients with ACS. The CG adherence was assessed with 9 quality indicators: 1 point was assigned for each positive indicator; total score reflected CG adherence in each case. In ACS with ST elevation (STE-ACS) patients the rate of high CG adherence (8-9 points) was 60.6%, in ACS without ST-elevation (NSTE-ACS) - 51.2%. High CG adherence significantly reduced the 30-day and 6-month mortality in all ACS patients and 12-month mortality in STE-ACS patients. Low CG adherence (1-7 points) was accompanied by the increase by 16.8% the rate ofpatients with length of stay >14 days (OR=1.591, 95% CI: 1.094-2.312) and by 11.4% 1-year readmission for ACS (0R=0.406, 95% CI: 0.239-0.690). On conclusion, doctors ’ adherence to CG for ACS helps to reduce significantly hospital and post-discharge mortality, length of stay and the risk of 1-year read missions for ACS.

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