A cardiovascular risk score for hypertensive patients previously admitted to hospital

2019 ◽  
Vol 18 (6) ◽  
pp. 492-500 ◽  
Author(s):  
Ana M Martínez-Díaz ◽  
Antonio Palazón-Bru ◽  
David M Folgado-de la Rosa ◽  
Dolores Ramírez-Prado ◽  
Patricia Llópez-Espinós ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cox Regression ◽  
External Validation ◽  
Arterial Disease ◽  
Internal Validation ◽  
Hypertensive Patients ◽  
One Year

Background: Cardiovascular risk scales in hypertensive populations have limitations for clinical practice. Aims: To develop and internally validate a predictive model to estimate one-year cardiovascular risk for hypertensive patients admitted to hospital. Methods: Cohort study of 303 hypertensive patients admitted through the Emergency Department in a Spanish region in 2015–2017. The main variable was the onset of cardiovascular disease during follow-up. The secondary variables were: gender, age, educational level, family history of cardiovascular disease, Charlson score and its individual conditions, living alone, quality of life, smoking, blood pressure, physical activity and adherence to the Mediterranean diet. A Cox regression model was constructed to predict cardiovascular disease one year after admission. This was then adapted to a points system, externally validated by bootstrapping (discrimination and calibration) and implemented in a mobile application for Android. Results: A total of 93 patients developed cardiovascular disease (30.7%) over a mean period of 1.68 years. The predictors in the points system were: gender, age, myocardial infarction, heart failure, peripheral arterial disease and daily activity (quality of life). The internal validation by bootstrapping was satisfactory. Conclusion: A novel points system was developed to predict short-term cardiovascular disease in hypertensive patients after hospital admission. External validation studies are needed to corroborate the results obtained.

Long-term effects of a Swedish lifestyle intervention programme on lifestyle habits and quality of life in people with increased cardiovascular risk

2017 ◽  
Vol 46 (6) ◽  
pp. 613-622 ◽  
Author(s):  
Matthias Lidin ◽  
Elin Ekblom-Bak ◽  
Monica Rydell Karlsson ◽  
Mai-Lis Hellénius
Keyword(s):  
Quality Of Life ◽  
Cardiovascular Risk ◽  
Dietary Habits ◽  
Behavioural Change ◽  
University Hospital ◽  
Intervention Programme ◽  
Lifestyle Habits ◽  
Group Sessions ◽  
One Year

Aims: The aim of this study was to evaluate the effects of a structured intervention programme on lifestyle habits and quality of life after six months and one year in participants with increased cardiovascular risk. Methods: Participants aged ≥18 years with increased cardiovascular risk were referred from primary health care and hospitals. The programme was launched at an outpatient clinic in a department of cardiology at a university hospital. It consisted of individual visits to a nurse for a health check-up and lifestyle counselling at baseline, after six months and at one year. In addition, five group sessions – focusing on nicotine, alcohol, physical activity, eating habits, stress, sleep and behavioural change – were offered to the participants and their relatives or friends. Lifestyle habits and quality of life were assessed with questionnaires at baseline, after six months and at one year. Results: One hundred participants (64 women, 36 men, age 58±11 years) were included in the programme. Compared with the baseline, significant and favourable changes in reported lifestyle habits were noted. Exercise levels were higher after one year and sedentary time decreased from 7.4 to 6.3 h/day. Dietary habits improved and the number of participants with a high consumption of alcohol decreased. Quality of life improved after one year. Conclusions: Participating in a structured lifestyle programme resulted in improved lifestyle habits and quality of life over one year in people with increased cardiovascular risk. Components such as an inter-professional teamwork, a focus on lifestyle rather than the disease, and combining individual visits and group sessions, might be central to the positive outcome of the programme.

Prevalence, pattern and associated cardiovascular risk of t-wave inversion in hypertensive patients: a 5-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kasiakogias ◽  
D Konstantinidis ◽  
K Dimitriadis ◽  
F Tatakis ◽  
I Zammanis ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Hypertensive Patients ◽  
Cox Regression Analysis ◽  
T Wave ◽  
St Depression ◽  
Wave Inversion

Abstract Background Data on prevalence and associated prognosis of repolarization abnormalities among hypertensive patients are limited. Purpose We investigated the presence and extent of ST-segment and T-wave changes in a hypertensive population and their predictive ability for cardiovascular disease. Methods We studied 1851 white Caucasian hypertensive patients (age 58±12 years, 51%females) without a history of cardiovascular disease for a mean period of 5.3±3.4 years. At the baseline examination, all patients underwent standard 12-lead electrocardiography. T-wave inversion (TWI) was defined as T-wave deflection ≥−0.1 mV in ≥2 contiguous leads,unless associated with bundle branch block. Anterior, lateral or inferior TWI was defined as TWIin leads V2-V4 or V5,V6, I, AVL or II, aVF respectively. Thedepth in millimeters of TWI in each lead was recorded and the maximum depth per location was calculated. ST depression was defined as ≥1mm in depth in two or more contiguous leads.During follow-up, patients underwent clinic visits at least yearly for management of hypertension and risk factors. The outcome studied was theincidence of cardiovascular morbidity set as the composite of non-fatal coronary artery disease and stroke. Results In the entire population, prevalence of TWI was 3.8%, of which 39% presented withanterior TWI, 73% withlateral TWI and 11% with inferior TWI. ST depression was observed in 3.6% of patients (anterior in 0.8%, inferior in 0.9% and lateral in 2.6%). Incidence of the composite endpoint during follow-up was 4%. Cox regression analysis revealed that presence of TWI was associated with a significantly greater risk for cardiovascular events (HR: 2.6, 95% CI: 1.1–5.9, p=0.025). The association was stronger for lateral TWI (HR: 3.3, 95%: CI: 1.34–8.30, p=0.01) compared to other locations. In multivariate models controlling for standard confounders these associations were overall sustained. Depth of TWI and presence of ST depression were not associated with cardiovascular risk. Conclusions Among hypertensive patients without cardiovascular disease, TWI is infrequent but significantly associated with future cardiovascular events.Lateral TWI carries the worse prognosis Funding Acknowledgement Type of funding source: None

Clinical impact of exercise in patients with peripheral arterial disease

Vascular ◽  
2016 ◽  
Vol 25 (4) ◽  
pp. 412-422 ◽  
Author(s):  
Marko Novakovic ◽  
Borut Jug ◽  
Helena Lenasi
Keyword(s):  
Quality Of Life ◽  
Cardiovascular Risk ◽  
Exercise Training ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Walking Distance ◽  
Cardiovascular Parameters ◽  
Supervised Exercise ◽  
Peripheral Arterial

Increasing prevalence, high morbidity and mortality, and decreased health-related quality of life are hallmarks of peripheral arterial disease. About one-third of peripheral arterial disease patients have intermittent claudication with deleterious effects on everyday activities, such as walking. Exercise training improves peripheral arterial disease symptoms and is recommended as first line therapy for peripheral arterial disease. This review examines the effects of exercise training beyond improvements in walking distance, namely on vascular function, parameters of inflammation, activated hemostasis and oxidative stress, and quality of life. Exercise training not only increases walking distance and physiologic parameters in patients with peripheral arterial disease, but also improves the cardiovascular risk profile by helping patients achieve better control of hypertension, hyperglycemia, obesity and dyslipidemia, thus further reducing cardiovascular risk and the prevalence of coexistent atherosclerotic diseases. American guidelines suggest supervised exercise training, performed for a minimum of 30–45 min, at least three times per week, for at least 12 weeks. Walking is the most studied exercise modality and its efficacy in improving cardiovascular parameters in patients with peripheral arterial disease has been extensively proven. As studies have shown that supervised exercise training improves walking performance, cardiovascular parameters and quality of life in patients with peripheral arterial disease, it should be encouraged and more often prescribed.

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