scholarly journals Outcome of Early vs. Delayed Invasive Intervention in Acute Coronary Syndrome Patients Attending a Selected Specialized Hospital: A Comparative Study

2019 ◽  
Vol 11 (2) ◽  
pp. 129-138
Author(s):  
Masuma Jannat Shafi ◽  
Sahela Nasrin
Keyword(s):  
Intervention Group ◽  
Kidney Injury ◽  
Invasive Strategy ◽  
Repeat Revascularization ◽  
Coronary Syndrome ◽  
Duration Of Hospital Stay ◽  
Delayed Intervention ◽  
Ventilator Requirement ◽  
Invasive Intervention

Background: This study was to compare the outcome of early versus delayed invasive intervention in acute coronary syndrome (ACS) patients. Methods: A total of 200 patients with ACS underwent early intervention group (d”24 h, n=100) and delayed intervention group (>24 to 72 h, n=100) after percutaneous coronary intervention (PCI) were enrolled. The probable outcomes were a composite of re-infarction, acute LVF, recurrent ischemia, repeat revascularization, bleeding, stroke or death at 30 days. Results: Male were predominating (74%vs26%). Left anterior descending artery was the commonest infarct related artery in both groups (p=0.114). Cardiac markers, Cardiogenic shock, Acute left ventricular failure (LVF) and ventilator requirement were significantly higher (p=0.007, p=0.060, p=0.009, p=0.002) and mean duration of hospital stay was longer (p <0.001) in delayed intervention group. At 30 days follow-up improvement of chest pain, LVF and ejection fraction were achieved significantly in patient undergoing early intervention (p <0.001, p=0.016, 54.7±7.4 vs. 48.4±6.9; p <0.001). Adverse outcome like acute LVF (7% vs. 21%; p=0.004), re-infarction (0% vs. 7%; p=0.007), acute kidney injury (AKI) (5% vs. 17%; p=0.007), bleeding (11% vs. 18%; p=0.160), stroke (3% vs. 9%; p=0.074), repeat revascularization (1% vs. 7%; p=0.032), death (0% vs. 5%; p=0.030) was higher in delayed invasive intervention group (p=0.001). Conclusion: Acute LVF, ventilator requirement and duration of hospital stay were significantly predominating in delayed intervention group. Early invasive strategy in ACS patient associated with lower rates of acute LVF, acute kidney injury, re-infarction, stroke, bleeding, repeat revascularization and death compared with delayed invasive strategy at 30 days of follow-up. Cardiovasc. j. 2019; 11(2): 129-138

scholarly journals Nurse-led, telephone-based follow-up after acute coronary syndrome yields improved risk factors after 36 months: the randomized controlled NAILED-ACS trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Robin Henriksson ◽  
Daniel Huber ◽  
Thomas Mooe
Keyword(s):  
Acute Coronary Syndrome ◽  
Usual Care ◽  
Primary Outcome ◽  
Low Density Lipoprotein ◽  
Intervention Group ◽  
Density Lipoprotein ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
Target Values

AbstractWe investigated whether a nurse-led, telephone-based follow-up including medical titration was superior to usual care in improving blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) values 36 months after acute coronary syndrome (ACS). We screened all patients admitted with ACS at Östersund hospital, Sweden, between January 1, 2010, and December 31, 2014, for inclusion based on ability to participate in a telephone-based follow-up. Participants were randomly allocated to usual care or an intervention group that received counselling and medical titration to target BP < 140/< 90 mmHg and LDL-C < 2.5/< 1.8 mmol/L. The primary outcome was LDL-C at 36 months. Of 962 patients, 797 (83%) were available for analysis after 36 months. Compared to controls, the intervention group had a mean systolic BP (SBP) 4.1 mmHg lower (95% confidence interval [CI] 1.9–6.5), mean diastolic BP (DBP) 2.9 mmHg lower (95% CI 1.5–4.5), and mean LDL-C 0.28 mmol/L lower (95% CI 0.135–0.42). All P < 0.001. A significantly greater proportion of patients reached treatment targets with the intervention. After 36 months of follow-up, compared to usual care, the nurse-led, telephone-based intervention led to significantly lower SBP, DBP, and LDL-C and to a larger proportion of patients meeting target values.Trial registration: ISRCTN registry. Trial number ISRCTN96595458. Retrospectively registered.

Abstract 360: A Simplified Post-Discharge Telephone Intervention To Reduce Hospital Readmission for Patients with Cardiovascular Disease.

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Gene F Kwan ◽  
Lana Kwong ◽  
Yun Hong ◽  
Abhishek Khemka ◽  
Gary Huang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Statistical Significance ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
Phone Call ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Phone Calls ◽  
Administrative Assistants

Background: Readmission rates are high for patients with cardiovascular disease, particularly heart failure (HF) and acute coronary syndrome (ACS). Telephone calls by clinical staff have had mixed effects. We aim to evaluate the degree of implementation and the effect of a quality improvement initiative using a simplified post-discharge phone call by administrative assistants. Methods: Clinical data were retrospectively reviewed at a single urban public hospital. From January through October 2012 all patient discharged home from inpatient cardiology services (intervention group, n=1034 discharges) were identified. Within 7 days, administrative assistants contacted patients via telephone and queried regarding (1) medication compliance, (2) awareness of follow-up appointments and (3) if clinician contact is requested. Outcome events were defined as readmissions (for any cause) within 30 days to the same hospital and are reported as patients experiencing readmission, and total readmissions. A comparison group of all patients discharged home from inpatient cardiology services from January through October 2010 (n=746) were selected as controls (no phone calls). Categorical data were compared in a univariate fashion using the Chi Square test. Statistical significance is defined as p<.05. Results: Of the 1034 discharge events in the intervention group, 620 (60.0%) had phone calls attempted. Of those, 419 (67.6%) were directly contacted. Patients were statistically different with respect to language, ethnicity and insurance status. Of the patients called, 48 (7.7%) reported medication abnormalities, 13 (2.1%) did not understand their follow-up and 38 (6.1%) had a question for a clinician. The rates of patients experiencing events was not statistically different (132 [17.7%] vs. 156 [15.1%], OR 0.85, p=.14). Total readmissions were significantly reduced (157[21.0%] vs. 179 [17.3%], OR 0.82, p=.047). Pre-specified subgroups of ACS and HF patients showed a trend towards decreased re-admissions but were not statistically significant. Conclusion: A simplified post-discharge telephone call strategy is associated with a trend towards reduced hospital readmissions for cardiology patients. Further refinements are needed to improve program implementation.

scholarly journals Impacts of Residual SNYTAX Score on The Clinical Outcomes following Percutaneous Coronary Intervention in Chronic Coronary Syndrome Patients

2021 ◽  
Vol 2 (3) ◽  
pp. 20-24
Author(s):  
Wira Kimahesa Anggoro ◽  
Mohammad Saifur Rohman ◽  
Heny Martini ◽  
Pawik Supriadi ◽  
Cholid Tri Tjahjono ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Strong Predictor ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Repeat Revascularization ◽  
Coronary Syndrome ◽  
Residual Syntax Score ◽  
The Impact

Background: The residual SYNTAX score (RSS) can be used to measure the residual stenosis severity and complexity. The prognostic role of RSS in CCS patients is still unknown. We purposed to investigate the impact of RSS on the clinical outcomes following PCI in CCS patients. Methods: A prospective cohort study was performed. Based on the residual SYNTAX score, patients were divided into three groups: RSS 0, RSS 0 to 9.5, and RSS >9.5. The primary outcome was patient-oriented composite endpoint (POCE), including repeat revascularization, myocardial infarction, and all-cause mortality. Results: After 1-year follow-up period, patients in RSS >9.5 group revealed the greater POCE (4.3% vs. 6.4% vs. 23.9%; p = 0.016) than others. The repeat revascularization rate also was greater in the RSS >9.5 group (0.0% vs. 6.4% vs. 19.6%; p = 0.012). However, the hospitalization due to angina rates in all groups was not significantly different (4.3% vs. 4.2% vs. 4.3%; p = 1.000). The multivariate analysis revealed that RSS >9.5 was the strong predictor for repeat revascularization during 1 year follow-up (Odds ratio [OR] = 9.605; 95% confidence interval [CI] = 1.207 - 76.458; p = 0.033). Conclusion: The greater RSS was associated with the higher 1-year POCE and repeat revascularization rate in CCS patients. The high RSS was also the strong predictor for 1-year repeat revascularization for CCS patients.

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial

2020 ◽  
pp. 238008442096394
Author(s):  
P. Arrow ◽  
S. Piggott ◽  
S. Carter ◽  
R. McPhee ◽  
D. Atkinson ◽  
...  
Keyword(s):  
Intervention Group ◽  
Cluster Randomized Trial ◽  
Caries Experience ◽  
Atraumatic Restorative Treatment ◽  
Model Of Care ◽  
Aboriginal Communities ◽  
Restorative Treatment ◽  
Cluster Randomized ◽  
Delayed Intervention

Introduction: The management of early childhood caries (ECC) is challenging. Objectives: A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. Methods: Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. Results: A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. Conclusion: A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. Knowledge Transfer Statement: This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.

scholarly journals Timing of Invasive Strategy in Diabetic and Non-Diabetic Patients with Non-St-Segment Elevation Acute Coronary Syndrome

Folia Medica ◽  
2013 ◽  
Vol 55 (2) ◽  
pp. 16-25
Author(s):  
Nikolay G. Dimitrov ◽  
Iana I. Simova ◽  
Hristo F. Mateev ◽  
Maria R. Kalpachka ◽  
Pavlin S. Pavlov ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Arteriography ◽  
Diabetic Patients ◽  
Strategy Group ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Early Invasive Strategy

ABSTRACT INTRODUCTION: Patients with acute coronary syndrome without ST segment elevation are a heterogeneous group with respect to the risk of having a major adverse cardiac event (MACE). A history of diabetes mellitus (DM) is no doubt one of the factors that define a patient as being at a higher risk of having the syndrome. AIM: To compare early invasive strategy with selective invasive strategy indicated for patients with and without DM. PATIENTS AND METHODS: The study enrolled 178 patients with unstable angina or non-ST elevation myocardial infarction (UA/NSTEMI), and of these 52 (29.2%) had DM. Patients were randomly assigned to an early invasive strategy (these were scheduled to undergo coronary arteriography and percutaneous coronary intervention within 24 hours after admission) or to a selective invasive strategy (at first these were medically stabilized, with coronary arteriography required only in case of angina recurrence and/or evidence of inducible myocardial ischemia). The patients were followed up for a mean period of 22.8 ± 14 months. RESULTS: In the follow up the diabetics allocated to an early invasive strategy were found to have a significantly lower angina recurrence incidence (p = 0.005), rehospitalization rate (p = 0.001), fewer arteriographies (p = 0.001) and coronary interventions (p = 0.001) and low cumulative incidence of MACE (p = 0.008) in comparison with the diabetics assigned to selective invasive strategy. We also found, using the Kaplan-Meier curves survival analysis, that the time to MACE in patients assigned to an early invasive strategy was significantly longer than that in the group of selective invasive strategy. In the follow-up of non-diabetics we found no significant difference in MACE rate between the patients allocated to early invasive strategy and those assigned to selective invasive strategy. In the selective invasive strategy group, however, the cardiovascular adverse events tended to occur earlier than in the early invasive strategy group. CONCLUSIONS: Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndrome is associated with a reduced MACE rate compared with the selective invasive strategy used in these patients. Early invasive strategy applied in diabetic patients is also associated with a significantly longer time to MACE. In non-diabetics the advantages of early over selective invasive strategy are not so clearly differentiated.

Predictors and outcome of contrast-induced acute kidney injury in older patients presenting with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Bugani ◽  
E Tonet ◽  
R Pavasini ◽  
M Serenelli ◽  
D Mele ◽  
...  
Keyword(s):  
Older Patients ◽  
Adverse Outcome ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Abstract Background The number of older patients presenting with acute coronary syndrome (ACS) is increasing. Routine percutaneous coronary intervention (PCI) is performed in order to improve outcome, but comorbidities associated with aging lead to a higher risk of treatment complications. Contrast-induced acute kidney injury (CI-AKI) represents potential harm in older and frail patients, but its impact on long term prognosis is not clear. Purpose To evaluate occurrence, predictors, and impact on long term outcome of CI-AKI in elderly patients presenting with ACS. Methods A prospective cohort of 392 older (≥70 years) ACS patients who underwent coronary angiography was enrolled. CI-AKI was defined as a serum creatinine increase at least ≥0.3 mg/dl in 48 h or at least ≥50% in 7 days. According to our department protocol, prophylactic hydration was performed to all patients with isotonic saline, given intravenously at a rate of 1 ml/kg body weight/h (0.5 ml/kg for patients with left ventricular ejection fraction &lt;35%) for 12 h before (unless for emergent patients) and 24 h after PCI. Median follow up was 4 [3.0–4.1] years. Long term adverse outcomes include all-cause mortality and any hospitalization for cardiovascular causes (ACS, heart failure, arrhythmia, cerebrovascular accident). Results CI-AKI was observed in 72 patients (18.4%). Among patients who developed or not CI-AKI, no difference was found between clinical presentation (Non-ST segment elevation myocardial infarction (NSTEMI) vs. STEMI), left ventricular ejection fraction and multivessel coronary disease. Estimated glomerular filtration rate (odd ratio (OR) 3.59, confidence interval (CI) 1.79–7.20, p&lt;0.001), contrast media volume (OR 1.006, CI 1.002–1.009, P=0.001), white blood cells (OR 1.18, CI 1.10–1.27, p&lt;0.001), haemoglobin level (OR 0.81, CI 0.70–0.94, p=0.005) and chronic obstructive pulmonary disease (OR=5.37, CI 2.24–12.90, p&lt;0.001) were independent predictors for CI-AKI. Patients with CI-AKI presented increased mortality rate both at 30-days (2.7% vs 0%, p=0.038) and at 4-years follow-up (all cause death 23.6 vs. 11.6%, p=0.013) (Figure 1: long term adverse outcomes). Multivariable Cox proportional hazards analysis revealed that diabetes (hazard ratio, HR 1.99, CI 1.33–2.97, p=0.001), atrial fibrillation (HR 2.49, CI 1.59–3.91, p&lt;0.001), Killip class &gt;1 (HR 2.20, CI 1.32–3.67, p=0.003) and haemoglobin level (HR 0.84, CI 0.76–0.92, p&lt;0.001) were independently associated with adverse outcome, while CI-AKI represent a risk factor only at univariate analysis. Conclusions CI-AKI is a common complication among older adults undergoing coronary angiography for ACS. Patients who developed CI-AKI had worse outcome at long term follow-up. Actually, the occurrence of CI-AKI was not identified as an independent predictor for long-term adverse outcome, while it may represent a marker of severity of comorbidity and consequent poor prognosis, rather than a causal agent itself. Figure 1. Kaplan-Maier Curve Funding Acknowledgement Type of funding source: None

Secondary prevention programme of ischaemic heart disease in the elderly: A randomised clinical trial

2017 ◽  
Vol 25 (3) ◽  
pp. 278-286 ◽  
Author(s):  
Elisenda Marcos-Forniol ◽  
José F Meco ◽  
Emili Corbella ◽  
Francesc Formiga ◽  
Xavier Pintó
Keyword(s):  
Risk Factor ◽  
Mediterranean Diet ◽  
Intervention Group ◽  
Prevention Programme ◽  
Control Group ◽  
Risk Factor Control ◽  
Coronary Syndrome ◽  
Mediterranean Diet Adherence

Background Elderly patients have been underrepresented in secondary cardiovascular prevention programmes. This study aimed to ascertain the effects of a secondary coronary disease prevention programme in these patients. Design Open randomised intervention study with parallel groups. Methods One hundred and twenty-seven patients aged ≥70 years with a recent acute coronary syndrome were randomised to a protocolised clinical intervention plus usual care (intervention group, n = 64) or to usual care alone (control group, n = 63). Patients were assessed at baseline and after 12 months. The main outcome was the percentage of patients with optimal risk factor control after 12 months of follow-up. Secondary outcomes included changes in Mediterranean diet adherence, quality of life and functionality. Mortality was evaluated three years after the end of the intervention. Results One hundred and six patients (83.4%) completed 12 months of follow-up (54 in the intervention group and 52 in the control group). At the end of intervention, 34.2% more patients in the intervention group had achieved optimal risk factor control with a number needed to treat of 3 (relative risk 2.18, 95% confidence interval 1.36 to 3.50). The intervention group improved adherence to the Mediterranean diet ( p = 0.013) and functionality assessed by the Short Physical Performance Battery ( p = 0.047). No differences between groups were found in quality of life (Short-Form 36 Health Survey) or mortality after three years (hazard ratio 1.19, 95% confidence interval 0.41 to 3.45). Conclusions A secondary coronary disease prevention programme in elderly patients with a recent acute coronary syndrome improved risk factor control, Mediterranean diet adherence and functionality.

P6212The NAILED ACS trial - telephone-based long-term follow-up reduces risk factors after 36 months

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Henriksson ◽  
D Huber ◽  
T Mooe
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Usual Care ◽  
Diastolic Blood Pressure ◽  
Intervention Group ◽  
Control Group ◽  
Treatment Targets ◽  
Coronary Syndrome ◽  
Target Values

Abstract Background Cardiovascular secondary preventive strategies need improvement. The proportion of patients reaching guideline recommended treatment targets are low. Purpose We investigated if nurse-led, telephone-based follow-up including medical titration was superior to usual care in controlling blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels 36 months after an acute coronary syndrome (ACS). Methods All patients admitted with ACS at the local county hospital between 1st January 2010 and 31st December 2014 were screened for inclusion based on their ability to participate in a telephone-based follow-up. Participants were randomized into two parallel groups, an intervention group and a control group receiving usual care. BP and LDL-C were measured at one month, 12, 24 and 36 months. The intervention group received counseling and medical titration to attain treatment targets of BP (<140/<90 mmHG) and LDL-C (<2.5/<1.8 mmol/L). The primary outcome was LDL-C at 36 months. Results Out of 962 randomized patients, 797 were available for analysis after 36 months. In the intervention group, mean systolic blood pressure (SBP) was 4.1 mmHg lower (95% CI 1.7 - 6.4, p=0.001), diastolic blood pressure (DBP) was 2.8 mmHg lower (95% CI 1.4- 4.4, p<0.001) and mean LDL-C was 0.26 mmol/L lower (95% CI 0.12 - 0.4, p<0.001) when compared to the control group. The proportion of patients reaching treatment target goals was also significantly higher in the intervention group. Conclusions After 36 months of follow-up the nurse-led, telephone-based intervention led to significantly lower systolic blood pressure, diastolic blood pressure and LDL-C levels when compared to the control group. The intervention group also had a larger proportion of patients reaching target values. Acknowledgement/Funding The study received funding from the research and development unit, Region Jämtland Härjedalen.

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