scholarly journals Improving Smoking Cessation After Myocardial Infarction by Systematically Implementing Evidence-Based Treatment Methods: A Retrospective Observational Cohort Study

2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
High Risk Group ◽  
Routine Practice ◽  
Evidence Based ◽  
Post Discharge ◽  
Beneficial Effects ◽  
Before And After ◽  
Observational Cohort ◽  
Short Consultation

Abstract We compared the odds of smoking cessation at 2-months post-myocardial infarction (MI) before and after implementing routines, optimizing the use of evidence-based methods for smoking cessation, with start during admission. The following routines were implemented at six hospitals in Sweden: cardiac rehabilitation nurses offering smokers short consultation during admission, optimizing nicotine replacement therapy, increasing prescription of varenicline, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months post-MI before (n = 188) and after (n = 195) routine implementation were compared. Secondary outcomes included adherence to implemented routines. After implementation, a larger proportion of patients (65% vs 54%) were abstinent at 2-months (OR 1.60 [1.04–2.48], p = 0.034). Including only those counselled during admission, 74% were abstinent (OR 2.50 [1.42–4.41], p = 0.002). After implementation patients were more often counselled during admission (50% vs 6%, p < 0.001), prescribed varenicline (23% vs 7%, p < 0.001), and contacted by telephone post-discharge (18% vs 2%, p < 0.001). Being prescribed varenicline had the strongest association with smoking abstinence at 2-months (adjusted OR 4.09 [1.68-10.00], p = 0.002). In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects on smoking cessation for the high-risk group of smoking MI patients.

scholarly journals Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Ögmundsdottir Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Prognostic Value ◽  
Routine Practice ◽  
Evidence Based ◽  
Post Discharge ◽  
Evidence Based Treatment ◽  
Beneficial Effects ◽  
Before And After ◽  
Secondary Outcomes

AbstractWe compared the odds of smoking cessation at 2-months post-myocardial infarction (MI), before and after implementing routines optimizing use of evidence-based smoking cessation methods, with start during admission. The following routines were implemented at six Swedish hospitals: cardiac rehabilitation nurses offering smokers consultation during admission, optimizing nicotine replacement therapy and varenicline prescription, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months before (n smokers/n admitted = 188/601) and after (n = 195/632) routine implementation were compared. Secondary outcomes included adherence to implemented routines and assessing the prognostic value of each routine on smoking cessation. After implementation, a larger proportion of smokers (65% vs. 54%) were abstinent at 2-months (OR 1.60 [1.04–2.48]). Including only those counselled during admission (n = 98), 74% were abstinent (2.50 [1.42–4.41]). After implementation, patients were more often counselled during admission (50% vs. 6%, p < 0.001), prescribed varenicline (23% vs. 7%, p < 0.001), and contacted by telephone post-discharge (18% vs. 2%, p < 0.001). Being contacted by telephone post-discharge (adjusted OR 2.74 [1.02–7.35]) and prescribed varenicline (adjusted OR 0.39 [0.19–0.83]) predicted smoking cessation at 2-months. In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects for post-MI patients.

scholarly journals Improving Smoking Cessation After Myocardial Infarction by Systematically Implementing Evidence-Based Treatment Methods: A Retrospective Observational Cohort Study

2021 ◽  
Author(s):  
Margret Leosdottir ◽  
Sanne Wärjerstam ◽  
Halldora Ögmundsdottir Michelsen ◽  
Mona Schlyter ◽  
Emma Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Cardiac Rehabilitation ◽  
Post Myocardial Infarction ◽  
Optimal Dosage ◽  
Evidence Based ◽  
Post Discharge ◽  
Treatment Methods ◽  
Evidence Based Treatment

Abstract Background: Evidence-based methods for aiding smoking cessation post-myocardial infarction are effective yet underused in clinical practice. We compared the odds of smoking cessation at 2-months post-myocardial infarction before versus after implementing a set of pre-specified routines optimizing evidence-based treatment methods for smoking cessation, initiated during admission. Methods: Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation centres in Sweden. The routines included cardiac rehabilitation nurses providing current smokers hospitalized for acute myocardial infarction with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3-5 days after discharge, after which usual care follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Using logistic regression, we compared the odds for smoking cessation at 2-months post-discharge for currently smoking patients admitted (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at 2-months.Results: In total, 159 (85%) and 179 (92%) of enrolled patients attended the 2-month follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at 2-months (OR 1.60 [1.04-2.48], p=0.034). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at 2-months (OR 2.50 [1.42-4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p<0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p<0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p<0.001), compared to before. Being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at 2-months (adjusted OR 4.09 [1.68-10.00], p=0.002).Conclusions: Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking myocardial infarction patients.

scholarly journals Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods: a prospective observational cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Leosdottir ◽  
S Warjerstam ◽  
H Ogmundsdottir Michelsen ◽  
M Schlyter ◽  
E Hag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Smoking Cessation ◽  
Recurrent Event ◽  
Optimal Dosage ◽  
Evidence Based ◽  
Effective Measure ◽  
Treatment Methods ◽  
Evidence Based Treatment ◽  
Before And After

Abstract Background For smokers who suffer a myocardial infarction (MI), smoking cessation is the most effective measure to reduce recurrent event risk. Still, evidence-based treatment methods for aiding smoking cessation post-MI are underused. Purpose To compare the odds of smoking cessation at two-months post-MI before and after implementing a set of pre-specified routines for optimization of evidence-based treatment methods for smoking cessation, with start during admission. Methods Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation (CR) centres in Sweden. The routines included CR nurses providing current smokers hospitalized for acute MI with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3–5 days after discharge, after which usual care CR follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Patient data was retrieved from the SWEDEHEART registry and medical records. Using logistic regression, we compared the odds for smoking cessation at two-months post-MI for currently smoking patients admitted with MI (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at two-months. Results In total, 159 (85%) and 179 (92%) of enrolled patients attended the two-month CR follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at two-months (crude OR 1.60 [1.04–2.48], p=0.034) (Figure 1). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at two-months (crude OR 2.50 [1.42–4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p&lt;0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p&lt;0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p&lt;0.001), compared to before implementation. Crude and adjusted associations between each routine and smoking cessation at two-months are shown in Table 1. Entering all routines into the regression model simultaneously, being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at two-months (adjusted OR 4.09 [1.68–10.00], p=0.002). Conclusion Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking MI patients. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Swedish Heart and Lung AssociationPfizer AB

scholarly journals P259 Adherence to optimal medical therapy in Asian patients with acute myocardial infarction treated with PCI

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
T Koh ◽  
W Huang ◽  
F Gao ◽  
J C Allen ◽  
C Liman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Medical Therapy ◽  
Risk Group ◽  
High Risk Group ◽  
Primary Pci ◽  
Post Discharge ◽  
Asian Patients ◽  
Β Blockers

Abstract On Behalf SingCLOUD collaborators Background  Notable regional differences have been observed worldwide in clinical characteristics and outcomes in patients experiencing acute myocardial infarction (AMI). Asian patients present younger and report higher adverse outcomes rates compared to Western cohorts. The reasons are multifactorial, but adherence to medication prescription guidelines is one of the modifiable factors. Purpose  Our aim was to study the effect of physician adherence to Optimal Medical Therapy (OMT) prescription guidelines on a MACE outcome in a high-risk group of Asian AMI patients over 1 year following percutaneous coronary intervention (PCI). Method  Data for this retrospective study was from the Singapore Cardiac Longitudinal Outcomes Database (SingCLOUD) pilot study involving AMI patients surviving primary PCI at two tertiary centers from 2012 to 2013. Guideline-directed OMT adherence was defined as concurrent prescription of at least one statin plus dual antiplatelet therapy (DAPT – aspirin plus P2Y12-I). Prescription of β-blockers and ACE-i/ARBs was also recorded. Prescription status and MACE (repeat MI, stroke, death) was recorded at discharge, 3, 6 and 9 months, and 1 year following the index discharge. The cumulative effect of OMT adherence at 3, 6, 9 months and 1 year post-discharge was studied by comparing risk of first MACE among patient groups with complete, partial and non-adherence to OMT prescription guidelines. Results  2,478 patients, 80.3% males, mean age 60.3 ± 11.7 years were studied. 1094 (44.1%) underwent primary PCI for STEMI. Single drug prescription at discharge for aspirin, P2Y12-I, and statins was 95, 97 and 95.8%, while prescription of β -blockers and ACE-inhibitors was 86.5 and 75.7%. Prescription of statins and aspirin declined gradually while P2Y12-I fell to 67.9% at 6mo and 47.6% at 1 year. Adherence to OMT declined from 92.3% at discharge to 82.1, 58.5, 56.1 and 40.3% at 3, 6, 9 months and 1 year, respectively. Of 342 (13.8%) occurrences of first MACE, 48.5% occurred within 3mo post-discharge. Complete adherence to OMT upon discharge significantly decreased risk of MACE at 3mo (OR = 0.066; 95% CI: 0.054-0.080; p &lt; 0.001) and 12mo (OR = 0.017; 95% CI: 0.010-0.028; p &lt; 0.001) relative to non-adherence. Conclusion  Over the course of a year in this high-risk group of PCI-treated AMI patients, there was a reduction in prescription adherence to the minimally essential OMT. Complete OMT adherence is beneficial in reducing MACE. Interventions targeting reasons for non-adherence are important in improving patient outcomes. Abstract P259 Figure 1 - Medication over 1 year

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 16415: Switching of ADP Receptor Inhibitor After Hospital Discharge Among Myocardial Infarction Patients: Insights From the TRANSLATE-ACS Observational Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marjorie E Zettler ◽  
Eric D Peterson ◽  
Lisa A McCoy ◽  
Mark B Effron ◽  
Kevin J Anstrom ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
First Year ◽  
Severe Bleeding ◽  
Bleeding Events ◽  
Post Discharge ◽  
Before And After ◽  
Adp Receptor

Background: With the availability of several ADP receptor inhibitors (ADPri), switching between agents is known to occur. However, among myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI), the incidence and patterns of post-discharge ADPri switching are unknown. Methods: Using data from the TRANSLATE-ACS study (2010-2012), we assessed the incidence of post-discharge ADPri switching among 8672 MI patients who were discharged after PCI and remained on ADPri therapy through 1 year post-MI. We examined bleeding and major adverse cardiovascular events (MACE: MI, stroke, unplanned revascularization) within 7 days before and after switching. Results: During the first year after index MI discharge, 663 patients (7.6%) had a switch in ADPri; switching occurred at a median of 50 days (IQR 7-154) post-discharge. Switching occurred most frequently in patients discharged on ticagrelor (64/226, 28.3%), then prasugrel (383/2489, 15.4%), and clopidogrel (216/5957, 3.6%, p<0.001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel; 87.5% of ticagrelor switches were to clopidogrel. Among clopidogrel patients who switched, 55 (25.5%) had a MACE event in the 7 days preceding switch. Among prasugrel and ticagrelor patients who switched, a GUSTO moderate/severe bleeding event occurred in 5 (1.3%) and 1 (1.5%) patients, respectively, in the 7 days preceding switch. Patients switched from prasugrel or ticagrelor most often cited cost as a reason for the switch (43.6% and 39.1%, respectively), while 60.7% of patients switched from clopidogrel attributed the switch to a physician decision. In the week following a switch, both MACE and major bleeding events were infrequent (table). Conclusions: ADPri switching occurred infrequently within the first year post-MI. Switching occurred more commonly among patients discharged on higher potency ADPri, but only a minority of these switches were triggered by bleeding.

Application of Evidence-based Nursing Intervention Combined with PBL Teaching Model in Nursing of Acute Myocardial Infarction and Its Effects on Quality of Life and Satisfaction of Patients

2021 ◽  
Vol 7 (5) ◽  
pp. 3967-3974
Author(s):  
Yuan Xue ◽  
Minxia Lu ◽  
Bingqing Lu ◽  
Yongming He
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Self Care ◽  
Teaching Model ◽  
Evidence Based ◽  
Nursing Satisfaction ◽  
Teaching Mode ◽  
Before And After ◽  
Evidence Based Nursing

Objective. To explore the application of evidence-based nursing (EBN) intervention combined with PBL teaching mode in acute myocardial infarction (AMI) nursing and the effects on quality of life (QOL) and satisfaction of patients. Methods. Ninety AMI patients enrolled in our hospital (January 2019-January 2021) were chosen as the study subjects and equally randomized into group M and group N. Group N received conventional nursing, and group M received EBN combined with PBL teaching mode. The cardiac function indexes, self-care ability, disease awareness and nursing satisfaction were compared between the two groups. The self-care ability was scored by the Exercise of Self-Care Agency Scale (ESCA). The QOL of both groups before and after intervention was scored by the Generic Quality of Life lnventory-74 (GQOLI-74). The emotional state before and after intervention was evaluated by the Hospital Anxiety and Depression Scale (HAD). Results. After nursing, cardiac function indexes were markedly higher in group M than group N (P<0.001). Compared with group N, group M achieved notably higher ESCA scores (P<0.001), higher awareness of disease knowledge (P<0.001) and higher nursing satisfaction (P<0.05). After intervention, the GQOLI-74 score in group M was obviously higher while the HAD score was lower compared with group N (P<0.001). Conclusion. The implementation of EBN combined with PBL teaching model in AMI patients can effectively improve nursing satisfaction and QOL as well as alleviate the negative emotions, so as to create a harmonious nurse-patient relationship. Therefore, it is worth applying and promoting.

scholarly journals Performance Obligations to Improve Delivery of Hospital-Initiated Smoking Cessation Interventions: A Before-and-After Evaluation

2019 ◽  
Author(s):  
Kerri A Mullen ◽  
Kathryn L Walker ◽  
Laura A Hobler ◽  
George A Wells ◽  
Isabella A Moroz ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Positive Impact ◽  
Interrupted Time Series ◽  
Local Health Authority ◽  
Evidence Based ◽  
Local Health ◽  
Interrupted Time Series Analysis ◽  
Cessation Intervention ◽  
Number Of Patients ◽  
Before And After

Abstract Introduction This study evaluated whether introducing performance obligations (a policy intervention) to service agreements between hospitals (n = 15) and their local health authority: (1) improved provision of an evidence-based tobacco cessation intervention (the “Ottawa Model” for Smoking Cessation) and (2) changed the quality of the cessation intervention being delivered. Methods Interrupted time series analysis was used to evaluate the change in the proportion of smoker patients provided the Ottawa Model 3 years before and 3 years after introducing the performance obligations. Changes in secondary outcomes related to program quality were described using mean differences, risk differences, and risk ratios, as appropriate. Results The proportion and number of patients provided the Ottawa Model doubled in the 3-year period following introduction of the new policy—from 3453 patients (33.7%) in the year before to 6840 patients (62.8%) in the final assessment year. This resulted in a signification slope change (+9.2%; 95% confidence interval [CI] 4.5%, 13.9%; p = .01) between the pre- and post-obligation assessment periods, signifying the policy had a positive impact on performance. Quality and effectiveness of the in-hospital intervention remained steady. Conclusions Implementation of performance obligations by a healthcare funder increased delivery of an evidence-based smoking cessation intervention across multiple hospitals. Given the known health and economic impacts of smoking cessation interventions, health authorities and hospitals should consider pairing adoption of systematic interventions, like the Ottawa Model, with policy to enhance reach and impact. Implications • The hospital-based Ottawa Model for Smoking Cessation (OMSC) intervention has been shown to increase smoking abstinence, while reducing mortality and healthcare utilization. • The uptake of systematic, evidence-based interventions, like the OMSC, by hospitals has been relatively low despite the known positive impacts. • The introduction of smoking cessation performance obligations by a healthcare funder resulted in more patients receiving an OMSC intervention while in hospital, with no corresponding change in intervention quality or effectiveness. • Healthcare funders and hospitals should consider pairing the adoption of effective, systematic interventions, like the OMSC, with policy to enhance reach and impact.

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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