scholarly journals Szívinfarktust túlélt betegek terápiahűsége a másodlagos megelőzés szempontjából fontos gyógyszeres kezelésekhez

2017 ◽  
Vol 158 (27) ◽  
pp. 1051-1057 ◽  
Author(s):  
András Jánosi ◽  
Péter Ofner ◽  
Zoltán Kiss ◽  
Levente Kiss ◽  
Róbert Gábor Kiss ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Beta Blockers ◽  
Platelet Aggregation Inhibitors ◽  
Hospital Treatment ◽  
Evidence Based ◽  
Index Event ◽  
Aggregation Inhibitors ◽  
Observational Cohort ◽  
Long Term Prognosis ◽  
One Year

Abstract: Introduction and aim: The aim was to study the patients’ adherence to some evidence-based medication (statins, beta blockers, platelet and RAS inhibitors) after suffering a myocardial infarction, and its impact on the outcome. Method: Retrospective observational cohort study was carried out from the data of the Hungarian Myocardial Infarction Registry between January 1, 2013, and December 31, 2014. 14,843 patients were alive at the end of hospital treatment, from them, those who had no myocardial infarction or death until 180 days were followed for one year. The adherence was defined as the proportion of time from the index event to the endpoint (or censoring) covered with prescription fillings. The endpoint was defined as death or reinfarction. Information on filling prescriptions for statins, platelet aggregation inhibitors, beta blockers and ARB/ACEI-inhibitors were obtained. Multivariate regression was used to model adherence and survival time. Results: Good adherence (\>80%) to clopidogrel, statins, beta blockers, aspirin and ARB/ACEI was found in 64.9%, 54.4%, 36.5%, 31.7% and 64.0%, respectively. Patients treated with PCI during the index hospitalization had higher adherence to all medication (all p<0.01), except for beta-blocker (p = 0.484). Multivariate analysis confirmed that adherence to statins, to clopidogrel and ARB/ACEI-inhibitors was associated with 10.1% (p<0.0001), 10.4% (p = 0.0002) and 15.8% (p<0.0001) lower hazard of endpoint respectively for 25% points increase in adherence, controlling for age, sex, performing of PCI, 5 anamnestic data and date of index event. Adherence to aspirin and beta blockers was not significantly associated with the hazard. Conclusion: Higher adherence to some evidence-based medications was found to be associated with improved long term prognosis of the patients. Orv Hetil. 2017; 158(27): 1051–1057.

Abstract 332: Persistent Use Of Evidence-Based Medications After Discharge Among Patients With Non-ST Elevation Myocardial Infarction Treated At Academic Versus Non-Academic Hospitals

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Jennifer Rymer ◽  
Lisa McCoy ◽  
Laine Thomas ◽  
Eric Peterson ◽  
Tracy Wang
Keyword(s):  
Myocardial Infarction ◽  
Beta Blockers ◽  
St Elevation Myocardial Infarction ◽  
Hospital Treatment ◽  
Evidence Based ◽  
Post Discharge ◽  
Academic Hospitals ◽  
St Elevation ◽  
And Gender

Background: While academic hospitals are more likely to apply evidence-based therapies in-hospital for patients with non-ST elevation myocardial infarction (NSTEMI) than non-academic hospitals, differences in post-discharge persistence of evidence-based medications have never been evaluated. Methods: We examined 3,184 NSTEMI patients over age 65 treated at 250 hospitals in 2006 in the CRUSADE registry linked to Medicare part D pharmacy data. Using multivariable Poisson regression adjusting for case mix, we compared continued filling of prescriptions for beta-blockers, ACEI/ARB, clopidogrel, and statins at 90 days and 1 year post-discharge between patients treated at academic and non-academic hospitals. Results: Patients treated at academic hospitals were more frequently non-white (19% vs. 8%, p<0.001), but age (median 76 years) and gender (53% female) were not significantly different from patients treated at non-academic hospitals. Patients at academic hospitals were more likely to have a Charlson score >4 (36% vs. 30%, p=0.001), yet the rates of in-hospital PCI (48%) and CABG (8%) were similar between groups. Rates of persistence to evidence-based medications did not differ substantially between patients treated at academic vs. non-academic hospitals at 90 days or 1 year (Table). Persistence to all drug classes prescribed at discharge was low and not significantly different between academic and non-academic hospitals at 90 days (46% vs. 45%, p=0.44 with adjusted incidence rate ratio (IRR)=0.99 (0.95,1.04) and at 1-year (39% vs. 39%, p=0.93, adjusted IRR=1.02 (0.98,1.07)). There were no significant differences in index hospitalization duration (median 4 days, interquartile range (IQR) 3-6 for both, p=0.51) and time to first post-discharge cardiac follow-up visit (median 28 days [IQR 15-54] vs. 28 days [IQR 16-56], p=0.25) between patients treated at academic vs. non-academic hospitals. Conclusion: Rates of persistence to evidence-based medications were similar between older NSTEMI patients treated at academic vs. non-academic hospitals, and may reflect similar in-hospital treatment and post-discharge cardiac follow-up. However, persistence rates are low both early and late post-discharge, highlighting a continued need for quality improvement efforts to optimize post-MI management.

scholarly journals Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments

2020 ◽  
Vol 10 (1) ◽  
pp. 106
Author(s):  
Anton Gard ◽  
Bertil Lindahl ◽  
Nermin Hadziosmanovic ◽  
Tomasz Baron
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Cardiology Department ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
Long Term Prognosis ◽  
One Year

Aim: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. Methods: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. Results: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62–3.22), one year (HR 1.82; 95% CI 1.39–2.36) and five years (HR 1.62; 95% CI 1.32–1.98). Conclusions: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.

Abstract 184: Patterns of Outpatient Follow-up after Acute Myocardial Infarction: Follow-up Frequency is Associated with Utilization of Evidence-based Therapies

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Rebecca Vigen ◽  
Yan Li ◽  
Thomas M Maddox ◽  
Stacie Daugherty ◽  
Steven M Bradley ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Primary Outcome ◽  
Beta Blockers ◽  
Primary Care Providers ◽  
Risk Scores ◽  
Evidence Based ◽  
Care Providers ◽  
Multivariable Analyses

Background: ACC/AHA guidelines recommend that patients with acute myocardial infarction (AMI) follow-up within several weeks of hospital discharge. Recommendations regarding intensity of following-up in the year following AMI are not provided. The relationship between frequency of follow-up and use of evidence-based therapies following AMI is unknown. Methods: 6,838 patients from 2 multicenter prospective AMI registries, PREMIER and TRIUMPH registries were studied. We divided the number of patient self-reported outpatient follow-up visits with cardiologists, primary care providers, or both into tertiles: low, medium, and high. The primary outcome was use of statins, beta blockers, aspirin, ACE/ARBs, and a composite of all four medications at 12 months among eligible patients. The association between tertiles of visits following AMI among patients who had at least one visit and primary outcome was evaluated using hierarchical multivariable modified Poisson models. Results: Mean number of follow-up visits in the year following AMI was 6 (IQR 3 - 8) and 189 (4%) of patients had no visits. In lowest tertile, patients had 1 to < 4 visits, in the medium tertile, 4 to < 7 visits, and in highest tertile, 7 to 59 visits. Patients in medium and high intensity tertiles were older, more likely to have insurance, and had higher GRACE 6-month mortality risk scores compared to the lowest tertile. In multivariable analyses, patients in the medium tertile were more likely to use statins and ASA than those in the lowest tertile (Figure). There were no differences in use of individual medications when comparing the highest and medium tertiles although individuals in the highest tertile were less likely to use all four medications. Conclusions: Significant variability exists in follow-up frequency following AMI and 4% of the cohort had no follow-up. Patients who had medium intensity visits were more likely to use some evidence-based medications than those with low intensity. Higher intensity visits was not associated with greater medication use. It is possible that the observed differences may be attributed to unmeasured differences among patients rather than the actual follow-up visits. Prospective studies are needed to assess key elements of outpatient visits that may lead to better utilization of evidence-based therapies.

scholarly journals Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury

2020 ◽  
pp. 204748732090691
Author(s):  
Marije Marsman ◽  
Judith AR van Waes ◽  
Remco B Grobben ◽  
Corien SA Weersink ◽  
Wilton A van Klei
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Functional Capacity ◽  
Myocardial Injury ◽  
Added Value ◽  
Cardiac Complications ◽  
Tertiary Referral Hospital ◽  
Postoperative Myocardial Infarction ◽  
Observational Cohort ◽  
One Year

Background Functional capacity is used as an indicator for cardiac testing before non-cardiac surgery and is often performed subjectively. However, the value of subjectively estimated functional capacity in predicting cardiac complications is under debate. We determined the predictive value of subjectively assessed functional capacity on postoperative cardiac complications and mortality. Design An observational cohort study in patients aged 60 years and over undergoing elective inpatient non-cardiac surgery in a tertiary referral hospital. Methods Subjective functional capacity was determined by anaesthesiologists. The primary outcome was postoperative myocardial injury. Secondary outcomes were postoperative inhospital myocardial infarction and one year mortality. Logistic regression analysis and area under the receiver operating curves were used to determine the added value of functional capacity. Results A total of 4879 patients was included; 824 (17%) patients had a poor subjective functional capacity. Postoperative myocardial injury occurred in 718 patients (15%). Poor functional capacity was associated with myocardial injury (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5–2.0; P < 0.001), postoperative myocardial infarction (RR 2.9, 95% CI 1.9–4.2; P < 0.001) and one year mortality (RR 1.7, 95% CI 1.4–2.0; P < 0.001). After adjustment for other predictors, functional capacity was still a significant predictor for myocardial injury (odds ratio (OR) 1.3, 95% CI 1.0–1.7; P = 0.023), postoperative myocardial infarction (OR 2.0, 95% CI 1.3–3.0; P = 0.002) and one year mortality (OR 1.4, 95% CI 1.1–1.8; P = 0.003), but had no added value on top of other predictors. Conclusions Subjectively assessed functional capacity is a predictor of postoperative myocardial injury and death, but had no added value on top of other preoperative predictors.

P3614Impact of renal dysfunction in patients with acute myocardial infarction on early management and outcome: a first observational French study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Bernard ◽  
C El Khoury ◽  
L Fraticelli
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Hospital Mortality ◽  
Real Life ◽  
Patient Characteristics ◽  
Hospital Treatment ◽  
Kidney Dysfunction ◽  
Early Management ◽  
St Segment Elevation ◽  
One Year

Abstract Background Kidney dysfunction (KD) is largely associated to cardiovascular mortality. Purpose Analyse early management and outcome in real life of ST segment elevation myocardial infarction (STEMI) patients with KD compared to STEMI patients with normal renal function. Methods Using 10 years' data from OSCAR regional registry, we investigated the early management and outcome of all patients with STEMI. Kidney dysfunction (KD) has been defined by creatinine clearance (CrCl) <90mL/min and was assessed using Cockcroft-Gault (CG) equation. Among them, two groups were identified: patients with normal kidney function (NKF) (CrCl ≥90mL/min) and patients with KD (CrCl <90mL/min). KD patients were stratified into 3 groups: patients with mild KD (CrCl 60–90mL/min), patients with moderate KD (CrCl 30–60mL/min) and patients with severe KD (CrCl <30mL/min). The comparison of the groups concerned patient characteristics, therapeutic strategy and follow-up at 1, 6 and 12 months. Results Our study included 8 003 STEMI patients from 2009 to 2018, 4 234 (52.9%) of them with KD. Among these, 2441 (57.6%) patients had mild KD, 1494 (35.3%) moderate KD and 299 (7.1%) severe KD. NKF patients were younger than KD group (54 [48–61] vs 72 [63–81]). KD patients had more cardiovascular risk factors such as diabetes, hypertension and personal history of coronary disease (p<0.001), but were less smokers (p<0,001). KD patients presented less often chest pain, and more dyspnea or cardiac arrest (p<0,001). There was no difference in symptom-first medical contact delay (p=0.30). More than 14% of patients with KD presented with Killip≥2. In the KD group location of infarction was more often anterior and lateral. In-hospital treatment differed among the groups: KD patients received less prasugrel (11% vs 20%), ticagrelor (44% vs 49%), enoxaparin (70% vs 80%), morphine (29% vs 39%) or other analgesic (30% vs 35%), but more clopidogrel (33% vs 23%), diuretics (3% vs 0,7%) and catecholamines (5% vs 2%) (p<0.001). In-hospital mortality was higher in the KD group (9% vs 1%, p<0.001). One-year mortality was 14% in the KD group compared to 2% for patients with NKF (p<0.001). Also, in-hospital mortality was increasing exponentially with KD severity (2%, 8% and 24% for mild, moderate and severe KD) (p<0,001) as well as 1-year mortality (respectively 1%, 6% and 12% after 1 year) (p<0,001). Conclusion Kidney insufficiency is an independent risk factor for death in patients after myocardial infarction and was associated with poor prognosis at short- and long-term. We observed that mortality increased with KD severity. Despite a high cardiovascular risk, KD patients presenting STEMI are less likely to receive therapy, while having more co-morbidities and extended infarction. To achieve an optimal medical care of KD patients with STEMI, we should introduce evidence-based therapies in the acute phase.

scholarly journals Management of patients with acute ST-segment elevation myocardial infarction in Russian hospitals adheres to international guidelines

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001134 ◽  
Author(s):  
Anna V Kontsevaya ◽  
Katie Bates ◽  
Henrik Schirmer ◽  
Natalia Bobrova ◽  
David Leon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health System ◽  
Good Practice ◽  
Coronary Intervention ◽  
Primary Objective ◽  
Hospital Treatment ◽  
St Segment Elevation ◽  
St Segment ◽  
Observational Cohort ◽  
European Society Of Cardiology

ObjectiveRussia has one of the highest cardiovascular mortality rates. Modernisation of the Russian health system has been accompanied by a substantial increase in uptake of percutaneous coronary intervention (PCI), which substantially reduces the risk of mortality in patients with acute ST-elevation myocardial infarction (STEMI). This paper aims to describe contemporary Hospital treatment of acute STEMI among patients in a range of hospitals in the Russian Federation.MethodsThis study used data from a prospective observational cohort of 1128 suspected patients with myocardial infarction recruited in both PCI and non-PCI hospitals across 13 regions and multiple levels of the health system in Russia. The primary objective was to examine the use of reperfusion strategies in patients with STEMI.ResultsAmong patients reaching PCI centres within 12 hours of symptom onset, the vast majority received angiography and PCI, regardless of age, sex and comorbidity, in line with current European Society of Cardiology guidelines.ConclusionPatients reaching Russian hospitals are very likely to receive appropriate treatment, although performance varies. The best hospitals can serve as beacons of good practice as PCI facilities continue to expand across Russia where geography allows.

P764A quality improvement program for heart failure involving structured patient data, diagnosis and organization of care - results from the 4D heart failure project

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Matan ◽  
U Lofstrom ◽  
C Cabrera-Corovic ◽  
B L Eriksson ◽  
M Ekstrom ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Beta Blockers ◽  
Urban Region ◽  
Evidence Based ◽  
Improvement Programme ◽  
One Year ◽  
Ras Inhibitors ◽  
New Onset ◽  
Standardized Care

Abstract Background Heart failure (HF) management is suboptimal in Sweden despite available evidence-based treatments. Purpose We hypothesized that a comprehensive organizational improvement programme could improve HF management, treatment and outcome. Methods Between 2012 and 2017 a HF improvement programme (the 4D Heart Failure project) was conducted in an urban region in Sweden (>2.2 million inhabitants). The steering committee led working groups 2012–17 including all health care providers with 250 primary care centers to build a standardized care process. HF outpatient care was centralized at five hospital-based HF clinics and included multidisciplinary health care teams. The outcomes were: 1) prescription withdrawals of HF medication (RAS-inhibitors and beta-blockers, MRA) per year, expressed as percentage (%), 2) one-year all-cause mortality or heart failure readmission by multivariable Cox regression, 3) total number of admitted HF patients, subdivided by new-onset and previously known HF, per million inhabitants and year. Results Between 2012 and 2017, yearly visits to the five HF clinics increased 3.5 times from 3200 to 11700, to a total of 47400 visits or 15800 patients (average 3 visits/patient). Prescription withdrawals of MRAs for readmitted HF patients increased from 37% to 60%, of beta-blockers and RAS-inhibitors from 80 to 90%. Similar increases were noted for all admitted patients. One-year mortality or HF readmission was 48% (n=17124/35880) over the period and decreased significantly (adjusted HR 0.98 per year, 95% CI 0.97–0.99, p<0.001). Number of admitted HF patients, new-onset or readmitted HF patients decreased by 16%, 13% and 20%, respectively (p<0.0001, Figure). Numbers of admitted patients 2012-2017 Conclusion A comprehensive standardized care HF management programme in an urban region substantially increased access to multidisciplinary hospital-based HF clinics, and increased use of evidence-based medications. HF admissions and readmissions were reduced, as was the risk of one-year mortality or HF rehospitalization. Acknowledgement/Funding County of Stockholm and the Karolinska Institute

scholarly journals Myocardial Infarction Registry – 2010. Feasibility and first results

2011 ◽  
Vol 152 (32) ◽  
pp. 1278-1283 ◽  
Author(s):  
András Jánosi ◽  
Péter Ofner ◽  
Béla Merkely ◽  
Péter Polgár ◽  
Péter Andréka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Patient Care ◽  
Beta Blockers ◽  
Platelet Aggregation Inhibitors ◽  
Epidemiological Data ◽  
Heart Catheterization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Quality Control Tool

Authors present the methodology and first data of Hungarian Myocardial Infarction Register Pilot Study started 1st of January, 2010. The aim of the study is to collect epidemiological data on myocardial infarction, to examine the natural history of the disease and to investigate the main characteristics on patient care in the pilot area. The program is using standardized diagnostic criteria and predefined electronic data record forms (eCRF). The pilot area consists of 5 districts in the capital, and Szabolcs-Szatmár-Bereg county. The area has 997 324 inhabitants. Eight cardiology departments, 5 with heart catheterization facility (C) in Budapest, four hospitals with one C in Szabolcs-Szatmar-Bereg county have been responsible of the patients’ care. After starting the program 16 other hospitals joined the program from different parts of Hungary. Between 1st of January 2010 and 1st of May 2011 4293 patients were registered, among them 52.1% with ST segment elevation myocardial infarction (STEMI), 42.1% with non-ST segment elevation myocardial infarction (NSTEMI), while 3% of the patients had unstable angina, and 2.8% of the cases had other diagnosis or the hospital diagnosis was missing in the eCRF. Authors compare the patients care with STEMI in five districts of Budapest and Szabolcs-Szatmár-Bereg county. In Budapest 79.7% of the 301 STEMI patients were treated in C and 84.6% of them were treated with primary percutaneous intervention (pPCI). In Szabolcs-Szatmár-Bereg county 402 patients were registered with STEMI, 62.9% of them were treated in C, where 77% of them were treated with pPCI. The drugs (beta blockers, ACE inhibitors, statins) important for secondary prevention were given more often to patients treated in the capital, however no difference was found in the platelet aggregation inhibitors therapy. Hospital mortality of STEMI patients was 8% in the capital, and 10% in Szabolcs- Szatmár-Bereg county. Authors conclude that the web based myocardial infarction register is feasible and important to have reliable data on patient care and a necessary quality control tool. Authors propose to broaden this pilot program and to start a nationwide myocardial infarction register. Orv. Hetil., 2011, 152, 1278–1283.

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