Health-related quality of life increases after first-time acute myocardial infarction: A population-based study

Introduction Acute myocardial infarction (AMI) affects patients’ health-related quality of life (HRQOL). AMI may decrease HRQOL, thus negatively affecting QOL. However, the improvements in interventional treatment and early rehabilitation after AMI may have a positive effect on HRQOL. Aim We evaluated HRQOL in patients after the first AMI treated in a reference cardiology centre in Poland and assessed which clinical variables affect HRQOL after AMI. Material and methods We prospectively evaluated HRQOL in 60 consecutive patients suffering after their first AMI during the index hospitalisation and again after 6 months, using: (i) MacNew, (ii) World Health Organization Quality of Life (WHOQOL) BREF, and (iii) Short Form (SF) 36. Results As measured by the MacNew questionnaire, global, social, and physical functioning did not change (p≥0.063), whereas emotional functioning improved 6 months after AMI, compared to index hospitalisation (p=0.002). As measured by WHOQOL BREF, physical health, psychological health, and environmental functioning did not change (p≥0.321), whereas social relationships improved 6 months after AMI (p=0.042). As assessed by SF-36, the global HRQOL improved after AMI (p=0.044). Patients with improved HRQOL in SF-36 often had a higher baseline body mass index (p=0.046), dyslipidaemia (p=0.046), and lower left ventricle ejection fraction (LVEF; p=0.013). LVEF<50% was the only variable associated with improved HRQOL in multivariate analysis (OR 4.463, 95% CI 1.045 - 19.059, p=0.043). Conclusions HRQOL increased 6 months after the first AMI, especially in terms of emotional functioning and social relationships. Patients with LVEF<50% were likely to have improved HRQOL.

Unterschiede im epaAC© bei Patient_innen mit Herzinsuffizienz mit oder ohne Rehospitalisation

Zusammenfassung. Hintergrund: Herzinsuffizienz ist einer der häufigsten Gründe für eine Hospitalisation bei älteren Menschen. Rund 22,8 % der Betroffenen werden innerhalb von 30 Tagen nach einer stationären Betreuung wieder hospitalisiert. Das pflegerische Assessmentinstrument epaAC könnte Hinweise zu Risikofaktoren für eine Rehospitalisation geben. Ziel: Das Ziel war es, Gruppenunterschiede in den Items und Scores des epaAC Austrittsassessment zu identifizieren hinsichtlich des Endpunktes einer ungeplanten Rehospitalisation bis 30 Tage nach Index-Hospitalisation. Methoden: Unter Verwendung eines retrospektiven Fall-Kontroll-Designs wurden Unterschiede in den epaAC Variablen mittels deskriptiver und vergleichender Statistik untersucht. Chi-Quadrat-Test, Wilcoxon-Test und t-Test wurden mit zweiseitigem Alpha-Niveau α < 0,05 durchgeführt. Die Alphafehler-Kumulierung wurde mittels Benjamini & Hochberg-Korrektur berücksichtigt. Ergebnisse: Es wurden keine signifikanten Gruppenunterschiede in allen Items und Scores des Austritts-epaAC gefunden. Es liegt nur ein schwacher Hinweis vor, dass eine akute respiratorische Beeinträchtigung zum Zeitpunkt der Entlassung bei den Patient_innen mit Rehospitalisation häufiger vorliegt, als bei denjenigen ohne Rehospitalisation. Schlussfolgerungen: Die Items und Scores des Pflegeassessmentinstruments epaAC unterschieden sich nicht signifikant zwischen Patient_innen mit und ohne 30-tägiger Rehospitalisation. Weitere Untersuchungen zur Beurteilung des Potenzials des epaAC zur Vorhersage einer Rehospitalisation bei Herzinsuffizienz sind erforderlich.

Long-term outcomes of 265,737 patients hospitalised with atrial fibrillation and atrial flutter from 2008 to 2015

Background Atrial fibrillation/atrial flutter (AF/AFL) hospitalisations are common, however, little is known about the long-term outcomes of these episodes. Objective To examine the incidence of mortality, all-cause and cause-specific re-hospitalisations at up to 8 years after a hospitalisation for AF/AFL. Methods Unique patients hospitalised with a primary diagnosis of AF/AFL from 2008–2015 were identified using nation-wide hospitalisation data from Australia and New Zealand. All-cause mortality was the primary outcome. Secondary endpoints included all-cause and cause-specific re-hospitalisations. Results were reported as incident rate per 100 patient-years. Results We included 265,737 patients (mean age 69.9±13.9y, female 45.2%, elective 28.7%). The median length of stay was 1 day (Interquartile range [IQR] 0–4 days) and the median CHA2DS2-VASc score was 2 (IQR 1–2). During the index hospitalisation, 9,837 (3.7%) patients underwent catheter or surgical ablation and 52,634 (19.8%) underwent cardioversion. During the median follow-up time of 3.4 years (range 0–8.0 years), 53,669 patients died (incident rate of 5.7/100 patient-years) with a survival probability gradually decreasing from 92.8% (95% CI 92.7–92.9%) at 1-year to 65.4% (95% CI 64.9–65.8%) at 8-years post-discharge (Table 1 and Figure 1). All-cause re-hospitalisations occurred in 210,118 patients (incident rate of 22.2/100 patient-years) with a rehospitalisation-free survival probability of 7.1% (95% CI 6.9—7.3%) at the end of follow-up. Unplanned re-hospitalisations occurred more frequently than planned episodes (incident rate of 17.2 vs. 16.6/100 patient-years respectively). AF/AFL accounted for 25.1% of all-cause re-hospitalisations (incident rate of 8.9/100 patient-years) and the probability of freedom from re-hospitalisations for AF/AFL was 55.4% (95% CI 55.0–55.8%) at 8-years. Incident rates of re-hospitalisations for catheter ablation (1.5/100 patient-years), stroke (1.6/100 patient-years), heart failure (2.7/100 patient-years), and acute myocardial infarction (1.0/100 patient-years) were low. In subgroup analyses, worse survival was observed in female patients, older age groups, patients with comorbid heart failure, hypertension, diabetes, and those who did not undergo ablation during the index hospitalisation. Conclusion Nearly two-thirds of patients were surviving by 8-years following an AF/AFL hospitalisation with a low rate of re-hospitalisations for stroke, heart failure, and myocardial infarction. However, re-hospitalisations for recurrent atrial arrhythmia were common. Efforts to reduce re-hospitalisations, especially unplanned encounters, are required to improve patient outcomes. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of Australia

Trends of prescribing adherence of antiplatelet agents in Hong Kong patients with acute coronary syndrome: a 10-year retrospective observational cohort study

ObjectivesThe objective of this study is to examine the temporal trend of antiplatelet prescribing pattern during index hospitalisation discharge in Hong Kong (HK) acute coronary syndrome (ACS) population.DesignThe study is a retrospective observational cohort study.SettingThe study retrieved data from electronic health record from Hospital Authority (HA), HK.ParticipantsThe study included patients aged 18 years old or above, who were admitted to seven institutions under HA with diagnosis of ACS during 2008–2017.Primary and secondary outcome measuresThe primary outcome was the frequency of antiplatelet therapy prescription at the point of index hospitalisation discharge each year during 2008–2017. Association between demographics, baseline comorbidities, procedures and antiplatelet prescription were examined as secondary outcome using multivariate logistic regression model, with commonly used antiplatelet groups selected for comparison.ResultsAmong the included 14 716 patients, 5888 (40.0%) discharged with aspirin alone, 6888 (46.8%) discharged with dual antiplatelet therapy (DAPT) with clopidogrel, and 973 (6.6%) discharged with DAPT with prasugrel/ticagrelor. Prescribing rate of aspirin alone decreased substantially from 56.8% in 2008 to 27.5% in 2017. Utilisation of DAPT with clopidogrel increased from 33.7% in 2008 to 52.7% in 2017. Use of DAPT with prasugrel/ticagrelor increased from 0.3% in 2010 to 15.3% in 2017. Compared with those prescribed with DAPT with clopidogrel, male patients (adjusted OR (aOR) 1.34, 95% CI 1.09 to 1.65), patients with non-ST-elevation myocardial infarction (aOR 2.50, 1.98 to 3.16) or ST-elevation myocardial infarction (aOR 3.26, 2.59 to 4.09), use of glycoprotein IIb/IIIa (aOR 3.03, 2.48 to 3.68) or undergoing percutaneous coronary intervention (aOR 3.85, 3.24 to 4.58) or coronary artery bypass graft (aOR 6.52, 4.63 to 9.18) during index hospitalisation, concurrent use of histamine-2 receptor antagonists (aOR 1.35, 1.10 to 1.65) or proton pump inhibitors (aOR 3.57, 2.93 to 4.36) during index hospitalisation discharge were more likely to be prescribed with DAPT with prasugrel/ticagrelor. Patients with older age (aOR 0.97, 0.96 to 0.97), diabetes (aOR 0.68, 0.52 to 0.88), chronic kidney disease (aOR 0.43, 0.22 to 0.85) or concurrent use of oral anticoagulant (aOR 0.16, 0.07 to 0.42) were more likely to received DAPT with clopidogrel.ConclusionsUse of DAPT with prasugrel/ticagrelor was suboptimal yet improving during 2008–2017 in HK patients with ACS. Considering DAPT, predictors for clopidogrel prescription, compared with prasugrel/ticagrelor, were consistent with identified risk factors of bleeding.

Immediate versus staged revascularisation in multivessel coronary disease: an updated meta-analysis

Background Percutaneous coronary interventions (PCIs) are often aimed at the culprit vessel in acute coronary syndromes (ACSs) followed by revascularisation of other stenoses later in the index hospitalisation or shortly after discharge. PCI delay of non-culprit coronary vessels stenoses is supported by lower contrast fluid use and thrombocyte aggregation. Distinct coronary interventions increase the risk of both non- and coronary artery complications, e.g. acute abdominal and periphery artery bleeding, suggesting undertaking all PCIs at the same time. Purpose To assess the effect on mortality and re-myocardial infarction (MI) of immediate versus staged revascularisation in multivessel coronary disease, with the latter constrained to initial PCI of the culprit coronary vessel. Methods The syntax of “randomised controlled trial (RCT) & acute coronary syndrome & complete revascularisation” was undertaken in PubMed. Clinical characteristics were gathered at the index hospitalisation. The intervention scenario was acute coronary syndrome or not. Meta-analyses calculated relative risk (RR) reductions on outcomes of 1) mortality and 2) re-MI. Meta-regression assessed linear difference between interventional treatment benefits and baseline characteristics. Results A total of 148 studies was found. Of those, 8 was found eligible for further analyses and their baseline characteristics are shown in Table 1. Comparison of immediate versus staged revascularisation on mortality was nonsignificant (RR, 1.19; 95% CI: 0.78–1.81, p=0.43) (Figure 1). The impact of Immediate vs staged revascularisation on re-MI was also nonsignificant (RR, 0.83; 95% CI: 0.44–1.55, p=0.56). Meta-regression found no associations between the outcomes and study characteristics (not shown). Conclusion The intervention of immediate compared to staged revascularisation assessed on outcomes of all-cause mortality and re-MI were nonsignificant. Figure 1 Funding Acknowledgement Type of funding source: None

Development of a risk prediction model of potentially avoidable readmission for patients hospitalised with community-acquired pneumonia: study protocol and population

Introduction30-day readmission rate is considered an adverse outcome reflecting suboptimal quality of care during index hospitalisation for community-acquired pneumonia (CAP). However, potentially avoidable readmission would be a more relevant metric than all-cause readmission for tracking quality of hospital care for CAP. The objectives of this study are (1) to estimate potentially avoidable 30-day readmission rate and (2) to develop a risk prediction model intended to identify potentially avoidable readmissions for CAP.Methods and analysisThe study population consists of consecutive patients admitted in two hospitals from the community or nursing home setting with pneumonia. To qualify for inclusion, patients must have a primary or secondary discharge diagnosis code of pneumonia. Data sources include routinely collected administrative claims data as part of diagnosis-related group prospective payment system and structured chart reviews. The main outcome measure is potentially avoidable readmission within 30 days of discharge from index hospitalisation. The likelihood that a readmission is potentially avoidable will be quantified using latent class analysis based on independent structured reviews performed by four panellists. We will use a two-stage approach to develop a claims data-based model intended to identify potentially avoidable readmissions. The first stage implies deriving a clinical model based on data collected through retrospective chart review only. In the second stage, the predictors comprising the medical record model will be translated into International Classification of Diseases, 10th revision discharge diagnosis codes in order to obtain a claim data-based risk model.The study sample consists of 1150 hospital stays with a diagnosis of CAP. 30-day index hospital readmission rate is 17.5%.Ethics and disseminationThe protocol was reviewed by the Comité de Protection des Personnes Sud Est V (IRB#6705). Efforts will be made to release the primary study results within 6 months of data collection completion.Trial registration numberClinicalTrials.gov Registry (NCT02833259).