scholarly journals The impact of in-hospital cardiac rehabilitation program on medication adherence and clinical outcomes in patients with acute myocardial infarction in the Lazio region of Italy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salvatore Soldati ◽  
Mirko Di Martino ◽  
Alessandro Cesare Rosa ◽  
Danilo Fusco ◽  
Marina Davoli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medication Adherence ◽  
Cardiac Rehabilitation ◽  
Hospital Readmission ◽  
Lazio Region ◽  
All Cause Mortality ◽  
St Elevation ◽  
The Impact

Abstract Background Medication adherence is a recognized key factor of secondary cardiovascular disease prevention. Cardiac rehabilitation increases medication adherence and adherence to lifestyle changes. This study aimed to evaluate the impact of in-hospital cardiac rehabilitation (IH-CR) on medication adherence as well as other cardiovascular outcomes, following an acute myocardial infarction (AMI). Methods This is a population-based study. Data were obtained from the Health Information Systems of the Lazio Region, Italy (5 million inhabitants). Hospitalized patients aged ≥ 18 years with an incident AMI in 2013–2015 were investigated. We divided the whole cohort into 4 groups of patients: ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) who underwent or not percutaneous coronary intervention (PCI) during the hospitalization. Primary outcome was medication adherence. Adherence to chronic poly-therapy, based on prescription claims for both 6- and 12-month follow-up, was defined as Medication Possession Ratio (MPR) ≥ 75% to at least 3 of the following medications: antiplatelets, β-blockers, ACEI/ARBs, statins. Secondary outcomes were all-cause mortality, hospital readmission for cardiovascular and cerebrovascular event (MACCE), and admission to the emergency department (ED) occurring within a 3-year follow-up period. Results A total of 13.540 patients were enrolled. The median age was 67 years, 4.552 (34%) patients were female. Among the entire cohort, 1.101 (8%) patients attended IH-CR at 33 regional sites. Relevant differences were observed among the 4 groups previously identified (from 3 to 17%). A strong association between the IH-CR participation and medication adherence was observed among AMI patients who did not undergo PCI, for both 6- and 12-month follow-up. Moreover, NSTEMI-NO-PCI participants had lower risk of all-cause mortality (adjusted IRR 0.76; 95% CI 0.60–0.95), hospital readmission due to MACCE (IRR 0.78; 95% CI 0.65–0.94) and admission to the ED (IRR 0.80; 95% CI 0.70–0.91). Conclusions Our findings highlight the benefits of IH-CR and support clinical guidelines that consider CR an integral part in the treatment of coronary artery disease. However, IH-CR participation was extremely low, suggesting the need to identify and correct the barriers to CR participation for this higher-risk group of patients.

Impact of cardiac rehabilitation referral on one-year outcome after discharge of patients with acute myocardial infarction

2018 ◽  
Vol 26 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Matthias Hermann ◽  
Fabienne Witassek ◽  
Paul Erne ◽  
Hans Rickli ◽  
Dragana Radovanovic
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
St Elevation Myocardial Infarction ◽  
Multivariable Logistic Regression Analysis ◽  
St Elevation ◽  
One Year ◽  
Lost To Follow Up ◽  
The Impact

Background Cardiac rehabilitation after an acute myocardial infarction has a class I recommendation in the present guidelines. However, data about the impact on mortality in Switzerland are not available. Therefore, we analysed one-year outcome of acute myocardial infarction patients according to cardiac rehabilitation referral at discharge. Design and methods Data were extracted from the Swiss AMIS Plus registry and included patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, who were asked to give their informed consent to a telephone follow-up one year after discharge. Results From 10,141 patients, 1956 refused to participate in follow-up and 302 were lost to follow-up. There were 4508 (57.2%) patients with cardiac rehabilitation referrals compared with 3375 (42.8%) without. Patients referred to cardiac rehabilitation were younger (62.4 years vs. 68.8 years), more often male (77% vs. 70%), presented more often with ST-elevation myocardial infarction (63.5% vs. 52.1%) and, apart from smoking (44.0% vs. 34.9%), they had fewer risk factors, such as dyslipidaemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients referred to cardiac rehabilitation had a lower crude one-year all-cause mortality (1.7% vs. 5.8%; p < 0.001) and lower rates of re-infarction, rehospitalization for cardiovascular disease and intervention (all p < 0.005). In a multivariable logistic regression analysis, cardiac rehabilitation was an independent predictor for lower mortality rate (odds ratio 0.65; 95% confidence interval 0.48–0.89; p = 0.007). Conclusions Although the detailed data of cardiac rehabilitation programmes and patient participation were not available for this study, our data from 7883 acute myocardial infarction patients showed a better one-year outcome for patients with cardiac rehabilitation referrals than for those without.

scholarly journals Sample Timing, Diagnosis of Subclinical Thyroid Dysfunction and Mortality in Acute Myocardial Infarction: ThyrAMI1 Study

2019 ◽  
Vol 105 (4) ◽  
pp. e1299-e1306 ◽  
Author(s):  
Salman Razvi ◽  
Owain Leng ◽  
Avais Jabbar ◽  
Arjola Bano ◽  
Lorna Ingoe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Reference Interval ◽  
Reference Ranges ◽  
Diagnosis And Prognosis ◽  
Time Period ◽  
All Cause Mortality ◽  
The Impact

Abstract Objective The objective of this study was to determine the impact of blood sample timing on the diagnosis of subclinical thyroid dysfunction (SCTD) and mortality in patients with acute myocardial infarction (AMI). Patients, Design, and Main Outcome Measures Patients with AMI had thyroid function evaluated on admission between December 2014 and December 2016 and those with abnormal serum thyrotropin (TSH) had repeat thyroid function assessed at least a week later. The association between sample timing and SCTD was evaluated by logistic regression analysis. Secondary outcomes were confirmation of SCTD on repeat testing and all-cause mortality up to June 2018. Results Of the 1806 patients [29.2% women, mean (± standard deviation) age of 64.2 (±12.1) years] analyzed, the prevalence of subclinical hypothyroidism (SCH) was 17.2% (n = 311) and subclinical hyperthyroidism (SHyper) was 1.2% (n = 22) using a uniform TSH reference interval. The risk of being diagnosed with SCTD varied by sample timing in fully-adjusted models. The risk of SCH was highest between 00.01 and 06.00 hours and lowest between 12.01 and 18.00 hours, P for trend &lt;.001, and risk of SHyper was highest between 12.01 hours and 18.00 hours and lowest between 00.01 hours and 06.00 hours. Furthermore, time of the initial sample was associated with the risk of remaining in a SCH state subsequently. Mortality in SCH patients was not elevated when a uniform TSH reference interval was utilized. However, when time period–specific TSH reference ranges were utilized, the mortality risk was significantly higher in SCH patients with HR (95% CI) of 2.26 (1.01–5.19), P = .04. Conclusions Sample timing impacts on the diagnosis and prognosis of SCH in AMI patients. If sample timing is not accounted for, SCH is systemically misclassified, and its measurable influence on mortality is lost.

CLINICAL OUTCOMES OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER PERCUTANEOUS CORONARY INTERVENTION AMONG CARDIAC REHABILITATION AND NON CARDIAC REHABILITATION GROUPS-A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 25-27
Author(s):  
Saroj Mandal ◽  
Vignesh. R ◽  
Sidnath Singh
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Observational Study ◽  
Cardiac Rehabilitation ◽  
Prospective Observational Study ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Percutaneous Coronary ◽  
All Cause Mortality

OBJECTIVES To determine clinical outcome and to nd out the association between participation of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in cardiac rehabilitation programme. DESIGN A Prospective observational study. STUDY AREA : Department of Cardiology, Institute of Postgraduate Medical Education and Research,Kolkata. PARTICIPANTS: Patients aged ≥18 years who underwent PCI due to AMI. OUTCOME MEASURES The outcomes were subsequent myocardial infarction, revascularisation, all-cause readmission, cardiac readmission, all-cause mortality and cardiac mortality. RESULT: The data of 1107 patients were included and 60.07%% of them participated in CR program. The risks of revascularisation, all cause readmission and cardiac readmission among CR participants were compared. The results of those analysis were consistent and showed that the CR participants had lower allcause mortality ,cardiac mortality,all cause readmission, cardiac admission. However no effect was observed for subsequent myocardial infarction or revascularisation. CONCLUSIONS: It was suggested CR participation may reduce the risk of all-cause mortality ,cardiac mortality, all cause readmission and cardiac admission.

scholarly journals A kórelőzményben szereplő revascularisatiós műtét rövid és hosszú távú prognosztikai jelentősége szívinfarktus miatt kezelt betegekben

2021 ◽  
Vol 162 (5) ◽  
pp. 177-184
Author(s):  
András Jánosi ◽  
Tamás Ferenci ◽  
András Komócsi ◽  
Péter Andréka
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
St Elevation

Összefoglaló. Bevezetés: A szívinfarktust megelőző revascularisatiós beavatkozások prognosztikai jelentőségével kapcsolatban kevés elemzés ismeretes, hazai adatokat eddig nem közöltek. Célkitűzés: A szerzők a Nemzeti Szívinfarktus Regiszter adatait felhasználva elemezték a koszorúér-revascularisatiós szívműtétet (CABG) túlélt betegek prognózisát heveny szívinfarktusban. Módszer: Az adatbázisban 2014. 01. 01. és 2017. 12. 31. között 55 599 beteg klinikai és kezelési adatait rögzítették: 23 437 betegnél (42,2%) ST-elevációval járó infarktus (STEMI), 32 162 betegnél (57,8%) ST-elevációval nem járó infarktus (NSTEMI) miatt került sor a kórházi kezelésre. Vizsgáltuk a CABG után fellépő infarktus miatt kezelt betegek klinikai adatait és prognózisát, amelyeket azon betegek adataival hasonlítottunk össze, akiknél nem szerepelt szívműtét a kórelőzményben (kontrollcsoport). Eredmények: A betegek többsége mindkét infarktustípusban férfi volt (62%, illetve 59%). Az indexinfarktust megelőzően a betegek 5,33%-ánál (n = 2965) történt CABG, amely az NSTEMI-betegeknél volt gyakoribb (n = 2357; 7,3%). A CABG-csoportba tartozó betegek idősebbek voltak, esetükben több társbetegséget (magas vérnyomás, diabetes mellitus, perifériás érbetegség) rögzítettek. Az indexinfarktus esetén a katéteres koszorúér-intervenció a kontrollcsoport STEMI-betegeiben gyakoribb volt a CABG-csoporthoz viszonyítva (84% vs. 71%). Az utánkövetés 12 hónapja során a betegek 4,7–12,2%-ában újabb infarktus, 13,7–17,3%-ában újabb katéteres koszorúér-intervenció történt. Az utánkövetés alatt a CABG-csoportban magasabbnak találtuk a halálozást. A halálozást befolyásoló tényezők hatásának korrigálására Cox-féle regressziós analízist, illetve ’propensity score matching’ módszert alkalmaztunk. Mindkét módszerrel történt elemzés azt mutatta, hogy a kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a túlélést. Amennyiben a beteg kórelőzményében szerepelt a koszorúérműtét, az indexinfarktus nagyobb eséllyel volt NSTEMI, mint STEMI (HR: 1,612; CI 1,464–1,774; p<0,001). Következtetés: A kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a szívinfarktus miatt kezelt betegek életkilátásait. Orv Hetil. 2021; 162(5): 177–184. Summary. Introduction: Little analysis is known about the prognostic significance of revascularization interventions before myocardial infarction; no domestic data have been reported so far. Method: The authors use data from the Hungarian Myocardial Infarction Registry to analyze the prognosis of patients with acute myocardial infarction who had previous coronary artery bypass grafting (CABG). Between 01. 01. 2014. and 31. 12. 2017, 55 599 patients were recorded in the Registry: 23 437 patients (42.2%) had ST-elevation infarction (STEMI) and 31 162 patients (57.8%) had non-ST-elevation infarction (NSTEMI). The clinical data and prognosis of patients treated for infarction after CABG were compared with those of patients without a CABG history. Results: The majority of patients were male (59% and 60%, respectively). Prior to index infarction, CABG occurred in 5.33% of patients (n = 2965), which was more common in NSTEMI (n = 2357; 7.3%). The CABG patients were older and had more comorbidities (hypertension, diabetes mellitus, peripheral vascular disease). For index infarction, percutaneous coronary intervention was more common in STEMI patients in the control group compared to CABG (84% vs. 71%). At 12 months of follow-up, 4.7–12.2% of patients had reinfarction, and 13.7–17.3% had another percutaneous coronary intervention. During the full follow-up, the CABG group had higher mortality. Cox regression analysis and propensity score matching were used to correct for the effect of other factors influencing mortality. Both analyses showed CABG did not affect survival. In the CABG group, the index infarction was more likely to be NSTEMI than STEMI (HR: 1.612; CI 1.464–1.774; p<0.001). Conclusion: The history of CABG does not affect the life expectancy of patients treated for an acute myocardial infarction. Orv Hetil. 2021; 162(5): 177–184.

D-dimer and the incidence of heart failure and mortality after acute myocardial infarction

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316880 ◽  
Author(s):  
Xiaoyuan Zhang ◽  
Shanjie Wang ◽  
Jinxin Liu ◽  
Yini Wang ◽  
Hengxuan Cai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Plaque Rupture ◽  
Risk Of Death ◽  
Increased Risk ◽  
Clinical Covariates ◽  
All Cause Mortality ◽  
D Dimer

ObjectiveD-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association.MethodsWe enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality.ResultsOver a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models.ConclusionsD-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.

scholarly journals Circulating Marine and Vegetable Omega-3 at the Time of ST-Segment Elevation Myocardial Infarction and Incident Hard Clinical Endpoints

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1483-1483
Author(s):  
Aleix Sala-Vila ◽  
Iolanda Lázaro-López ◽  
Ferran Rueda ◽  
Germán Cediel ◽  
Antoni Bayés-Genís
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Hospital Readmission ◽  
Omega 3 ◽  
St Segment Elevation ◽  
Clinical Endpoints ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality

Abstract Objectives Dietary marine omega-3 eicosapentaenoic acid (EPA) is readily incorporated into cardiac cell membranes, partially replacing the omega-6 arachidonic acid (AA). Blood omega-3 is an objective marker of their intake over the last days. Increasing blood EPA at the time of a ST-segment elevation myocardial infarction (STEMI) relates to a smaller infarct size and preserved long-term left ventricular ejection fraction. We explored whether blood EPA at the time of STEMI also relates to a lower incidence of hard clinical endpoints. We also explored whether blood alpha-linolenic acid (ALA, the vegetable omega-3) modulates such association. Methods We prospectively included 944 consecutive patients treated with primary percutaneous coronary intervention in a single tertiary referral hospital. We determined fatty acids in serum phosphatidylcholine (PC) at 12 hours of evolution. The primary outcomes were cardiovascular disease-related hospital readmission and all-cause mortality after 3 years of follow-up. We constructed multivariable Cox proportional hazards models, calculating risk estimates as hazard ratios (HR). Results The mean age of the cohort was 61 years and 209 (22.1%) were women. During follow-up, 130 patients (13.8%) were readmitted for cardiovascular disease, and 108 (11.4%) died. After adjustment for known clinical predictors, multivariate analysis showed that EPA in serum PC at the time of STEMI inversely related to incident hospital readmission (HR, 0.74; 95% CI, 0.56–0.96; P = 0.024, for a 1 SD increase). Further adjustment for serum PC AA and ALA did not change the association. EPA in serum PC was found to be unrelated to 3-y total mortality. However, after including serum PC proportions of AA and ALA into the model, we observed a significantly decreased risk of mortality for ALA (HR, 0.65; 95% CI, 0.44–0.96; P = 0.030, for a 1 SD increase). Conclusions Increasing proportions of EPA and ALA in serum PC at the time of STEMI inversely relate to 3-y cardiovascular disease-hospital readmission and all-cause mortality, respectively. Dietary EPA and ALA act synergistically and are partners rather than competitors in improving prognosis in case of a STEMI. Funding Sources Instituto de Salud Carlos III, Spain; California Walnut Commission.

scholarly journals Impact of Center Volume on Outcomes in Myocardial Infarction Complicated by Cardiogenic Shock: A CULPRIT‐SHOCK Substudy

2021 ◽  
Author(s):  
Benedikt Schrage ◽  
Uwe Zeymer ◽  
Gilles Montalescot ◽  
Stephan Windecker ◽  
Pranas Serpytis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
High Volume ◽  
Baseline Risk ◽  
Volume Data ◽  
Center Volume ◽  
All Cause Mortality ◽  
Resuscitated Patients ◽  
The Impact

Background Little is known about the impact of center volume on outcomes in acute myocardial infarction complicated by cardiogenic shock. The aim of this study was to investigate the association between center volume, treatment strategies, and subsequent outcome in patients with acute myocardial infarction complicated by cardiogenic shock. Methods and Results In this subanalysis of the randomized CULPRIT‐SHOCK (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock) trial, study sites were categorized based on the annual volume of acute myocardial infarction complicated by cardiogenic shock into low‐/intermediate‐/high‐volume centers (<50; 50–100; and >100 cases/y). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment, and 1‐year all‐cause mortality were compared across categories. n=1032 patients were included in this study (537 treated at low‐volume, 240 at intermediate‐volume, and 255 at high‐volume centers). Baseline risk profile of patients across the volume categories was similar, although high‐volume centers included a larger number of older patients. Low‐/intermediate‐volume centers had more resuscitated patients (57.5%/58.8% versus 42.2%; P <0.01), and more patients on mechanical ventilation in comparison to high‐volume centers. There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies. There was no difference in 1‐year all‐cause mortality across volume categories (51.1% versus 56.5% versus 54.4%; P =0.34). Conclusions In this study of patients with acute myocardial infarction complicated by cardiogenic shock, considerable differences in adjunctive medical and mechanical support therapies were observed. However, we could not detect an impact of center volume on reperfusion success or mortality.

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