Detection of severe congenital heart defects in live-born infants in Norway 2017-2020.

AIM: The aims of this nationwide retrospective cohort study were to determine the time and causes of detection of severe congenital heart defects (CHDs) in live-born infants in Norway between 2017 and 2020. METHODS: Information regarding live-born infants with severe CHDs was retrieved from national registries and medical records. RESULTS: A total of 219 776 infants were born in Norway from 01.01.2017 to 31.12.2020. Severe CHDs were diagnosed in 442 (0.2%) infants. Of these, 376 (85%) infants were diagnosed either prenatally (n = 203, 46%) or before discharge from hospital after birth (n = 173, 39%). A total of 56 (13%) infants were discharged with undetected CHDs. Time of detection was unknown in 10 cases (2%). The most frequent undetected CHDs at discharge were coarctation of the aorta/aortic arch hypoplasia (n = 24), atrioventricular septal defect (n = 13), anomalous pulmonary venous connection (n = 5) and coronary artery anomalies (n = 4). Seven (13%) children with undetected CHD experienced circulatory collapse out of hospital. CONCLUSION: Most infants with severe CHDs in Norway were identified prior to hospital discharge. However, some infants were discharged undiagnosed. Awareness of undetected CHDs and immediate cardiac assessment in infants with signs of circulatory failure early in life are still important.

Fully digital self-screening for atrial fibrillation with patch electrocardiogram.

AIMS: Atrial fibrillation (AF) is the most common arrhythmia worldwide. The AF is associated with severe mortality, morbidity, and healthcare costs, and guidelines recommend screening people at risk. However, screening methods and organization still need to be clarified. The current study aimed to assess the feasibility of a fully digital self-screening procedure and to assess the prevalence of undetected AF using a continuous patch electrocardiogram (ECG) monitoring system. METHODS AND RESULTS: Individuals ≥65 years old with at least one additional risk factor for stroke from the general population of Norway were invited to a fully digital continuous self-screening for AF using a patch ECG device (ECG247 Smart Heart Sensor). Participants self-reported clinical characteristics and usability online, and all participants received digital feedback of their results. A total of 2118 individuals with a mean CHA2DS2-VASc risk score of 2.6 (0.9) were enrolled in the study [74% women; mean age 70.1 years (4.2)]. Of these, 1849 (87.3%) participants completed the ECG self-screening test, while 215 (10.2%) did not try to start the test and 54 (2.5%) failed to start the test. The system usability score was 84.5. The mean ECG monitoring time was 153 h (87). Atrial fibrillation was detected in 41 (2.2%) individuals. CONCLUSION: This fully digitalized self-screening procedure for AF demonstrated excellent feasibility. The number needed to screen was 45 to detect one unrecognized case of AF in subjects at risk for stroke. Randomized studies with long-term follow-up are needed to assess whether self-screening for AF can reduce the incidence of AF-related complications. CLINICAL TRIALS: NCT04700865.

Association of Troponin T measurements with long-term outcomes in patients with coronary artery disease participating in a secondary prevention trial.

BACKGROUND AND AIMS: Identification of high-risk patients in secondary cardiovascular prevention may be challenging, although risk stratification tools are available. Cardiac troponins might have predictive value in identification of high-risk patients. The aim of this study was to investigate the association between cardiac Troponin T (cTnT) levels following a coronary event and long-term outcomes. METHODS: This study was carried out as a subanalysis from a randomized controlled trial conducted at Sørlandet Hospital, Norway, where patients hospitalized with myocardial infarction (MI) or scheduled percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) were included between 2007 and 2017. Participants were followed-up for up to 10 years after the index event through out-patient consultations. cTnT was assessed at each consultation as well as information regarding new cardiovascular events or death. RESULTS: A total of 1278 patients (18-80 years) with complete measurements of cTnT were included. cTnT was elevated (≥ 14 ng/L) one year after the primary event in 241 (19%) of participants. Median follow-up was 5.7 [SD 2.7] years. Cox regression analyses showed reduced survival (adjusted HR 0.37, 95% CI 0.19-0.72; p = 0.003) and composite endpoint-free survival (adjusted HR 0.73, 95% CI 0.55-0.98; p = 0.04) in participants with elevated cTnT versus participants with low cTnT after adjustment for risk factors at inclusion and randomization assignment. CONCLUSIONS: Assessment of cTnT after coronary heart events may help identify patients at high risk of poor outcomes and might contribute to more focused secondary preventive treatment. TRIAL REGISTRATION: The study is registered in ClinicalTrials.gov (NCT00679237).

Sex differences in secondary preventive follow-up after coronary heart events.

BACKGROUND AND AIMS: Some studies point to sex differences in cardiovascular preventive practices. The aim of this study was to investigate differences in achievement of secondary preventive targets and long-term outcome in men and women after a coronary heart event. METHODS: This study was a subanalysis from a randomized controlled trial of hospital-based versus primary care-based secondary preventive follow-up at Sorlandet Hospital, Norway, 2007-2022 and included both groups. The main outcome was achievement of treatment targets two years after the index event. Event-free survival was calculated based on the composite of mortality, coronary intervention, stroke, or myocardial infarction during follow-up. Participants were followed-up for up to 10 years after the index event through out-patient consultations. RESULTS: In total, 337 women and 1203 men were eligible for the study. Due to loss of follow-up during the first two years after the index coronary event 106 (7%) participants were excluded from further analysis (53% withdrawal of consent, 12% death, and 35% other causes) leaving 307 (21%) women and 1127 (79%) men. After two years of follow-up we found no differences between women and men in achievement of blood pressure targets (61% vs. 59%; p = 0.57), LDL-cholesterol goals (64% vs. 69%; p = 0.15), HbA1c-goal in patients with diabetes (49% vs. 45%; p = 0.57), non-smoking (79% vs. 81%; p = 0.34), healthy diets (14% vs. 13%, p = 0.89), physical activity (55% vs. 58%; p = 0.38), use of acetylsalicylic acid (93% vs. 94%; p = 0.39), and use of lipid lowering therapy (92% vs. 94%; p = 0.15). After a median follow-up time of 5.0 [SD 3.2] years there were no differences between women and men regarding composite endpoint (89 [30.0%] vs. 345 [30.6]; p = 0.58), and composite endpoint-free survival did not differ between women and men (hospital-based follow-up HR for women versus men, 0.87, 95% CI 0.62-1.23; p = 0.44 and primary care service HR for women versus men 0.95, 95% CI 0.69-1.31; p = 0.78). CONCLUSIONS: The study show no sex differences in achievement of secondary preventive targets or composite endpoint after coronary heart events. However, many women and men did not achieve treatment goals, and further improvement in secondary prevention is needed. TRIAL REGISTRATION: The study is registered in ClinicalTrials.gov (NCT00679237).

A man in his sixties with acute chest pain. / Mann i 60-årene med akutte brystsmerter.

BACKGROUND: Chest pain is a frequent symptom of acute myocardial infarction, but the cause is not always coronary atherothrombosis. We present a case where the patient himself had made a correct non-cardiac diagnosis, but this was initially overlooked by the doctor. CASE PRESENTATION: A man with a history of cardiac infarction was admitted with acute chest pain and troponin elevation. Electrocardiogram suggested ST elevations, echocardiography showed a possible slight hypokinesia, and we primarily suspected an acute coronary syndrome. However, invasive coronary angiography was negative and a primary acute myocardial infarction was less likely. A renewed interview revealed that the patient had worked with a propane burner indoors without adequate ventilation. The patient himself suspected carbon monoxide poisoning. Arterial blood gas showed HbCO 27.4 %, which was unfortunately overlooked initially. The patient had carbon monoxide poisoning with symptoms of dizziness, hand ataxia and myocardial ischaemia. He received 100 % oxygen and HbCO was normalised. INTERPRETATION: The imbalance between oxygen demand and supply resulted in a type 2 cardiac infarction. A thorough medical history is crucial for correct diagnosis but can unfortunately be missed on a busy shift. This case illustrates the importance of the patient's own diagnostic assumption.

Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography.

BACKGROUND: Prehospital identification and selection of treatment strategy in patients with suspected non-ST-elevation myocardial infarction (NSTEMI) is challenging. The aim of this study was to evaluate the feasibility and diagnostic accuracy of prehospital ECG, troponin T (TnT) and transthoracic echocardiography (TTE) acquired by paramedics in early identification of NSTEMI. METHODS: Consecutive patients requesting an ambulance from Sorlandet Hospital, Norway due to chest pain between November 2017 and January 2020 were screened for inclusion in the study. One ambulance was equipped with ECG recorder, point-of-care TnT test and TTE scanner, and six paramedics were given necessary training. ECG, TnT result and TTE images were acquired prehospitally and transferred to an in-hospital cardiologist. NSTEMI was suspected in patients with ischaemic ECG changes, elevated TnT or myocardial regional wall motion abnormalities (RWMA) at TTE. RESULTS: A total of 253 patients were included in the study. ECG was interpretable by cardiologists in 243 (96%), TnT in 238 (94%) and TTE images in 240 (95%) patients. NSTEMI was the discharge diagnosis in 22 (9%) of these patients. Four (18%) patients with NSTEMI had ischaemic ECG changes, elevated TnT and RWMA at TTE. Eight (36%) patients with NSTEMI had positive findings at two of the diagnostic methods, six (27%) patients had positive findings at one, and four (18%) patients had no positive findings in any of the diagnostic methods. In three patients (14%) with NSTEMI, RWMA was the only positive test. The negative and positive predictive values for RWMA were 42% and 96%, respectively. CONCLUSIONS: Prehospital acquisition of ECG, TnT and interpretable TTE images by paramedics were feasible in most patients with chest pain. Based on these examinations, it was possible to identify the majority of cases with NSTEMI prehospitally and admit the patients directly to a hospital with facilities for percutaneous coronary intervention (PCI) for further treatment. TRIAL REGISTRATION NUMBER: NCT04223986.

Long-term hospital-based secondary prevention of coronary artery disease: a randomized controlled trial.

BACKGROUND AND AIMS: Despite established guidelines on secondary prevention of cardiovascular disease, practical implementation of treatment targets is deficient even in high-income countries. This study compared long-term hospital-based treatment with follow-up at primary health care regarding new cardiovascular events and achievement of treatment targets. METHODS: This randomized controlled trial at Sørlandet Hospital, Norway 2007-2021 included patients hospitalized due to myocardial infarction (n = 760) or after scheduled percutaneous coronary intervention (PCI) (n = 677) or coronary artery bypass grafting (n = 103). Patients were randomized to hospital-based secondary preventive care with consultations 2 weeks, 3 months, 6 months and 1 year after the index event and annually for up to 5 years, or follow-up at primary health care. Final data was collected after 10 years and hazard ratios were calculated using Cox regression analyses. RESULTS: Composite endpoint-free survival due to a lower rate of PCI improved in patients with hospital-based follow-up (n = 788) compared to patients followed-up at primary health care (n = 752) (HR 0.80, 95% CI 0.66-0.96; p = 0.02) but all-cause mortality was not reduced (HR 0.96, 95% CI 0.59-1.56; p = 0.86). At 1 year, LDL-cholesterol (2.1 [SD 0.7] versus 2.3 [SD 0.8] mmol/l; p < 0.001) and systolic blood pressure (132 [SD 16] versus 142 [SD 20] mm/Hg; p < 0.001) were lower in the hospital-based group, and the differences remained significant during the first 5 years. Other secondary preventive measures (smoking cessation, physical activity, body weight, glucose control, drug adherence) did not differ. CONCLUSIONS: Long-term hospital-based secondary preventive follow-up improved composite endpoint-free survival, but not mortality. Substantial risk factors remained unaddressed. The beneficial effects on blood pressure and LDL-cholesterol disappeared after annual consultations ceased. TRIAL REGISTRATION: The study is registered in ClinicalTrials.gov (NCT00679237) May 16, 2008.

Pharmacy-dispensed drugs for secondary prevention after myocardial infarction. / Forebyggende legemidler etter hjerteinfarkt utlevert fra apotek.

BACKGROUND: Secondary prophylactic drugs are important for avoiding further cardiovascular events after myocardial infarction. We have examined whether patients collect these drugs from pharmacies and whether there are differences in survival between those who collect versus do not collect the drugs. MATERIAL AND METHOD: All patients <80 years registered in the Norwegian Myocardial Infarction Registry in 2013-16 were included in the study. The Norwegian Prescription Database was used to determine whether patients collected their prescriptions from pharmacies. RESULTS: During the study period, 32 328 patients under the age of 80 were registered in the Norwegian Myocardial Infarction Registry, of whom 96 % were discharged alive. The proportion of patients who were prescribed acetylsalicylic acid was 95 %, two antiplatelet agents, 83 %; a statin, 90 %; beta-blockers, 76 %; and ACE inhibitors/AII receptor blockers, 55 %. The proportions of patients who collected each of these drugs from a pharmacy within six months were 94 %, 90 %, 96 %, 95 % and 94 %, respectively. The combined incidence of death, stroke and myocardial infarction during the follow-up period (median 944 days) was higher among patients who did not collect all of their prescribed drugs (adjusted HR 1.7; 95 % CI 1.6-1.8). Among patients who died, the median time to death was 509 days for those who collected all of their prescribed drugs versus 126 days for those who did not (p <0.001). INTERPRETATION: Most patients do collect prescribed drugs from a pharmacy after myocardial infarction. A shorter time to death among patients who do not collect the drugs may suggest a high degree of general morbidity in this group.

Long-term ECG recording: findings and implications. / Funn og konsekvenser ved langtidsregistrering av EKG.

BACKGROUND: Long-term ECG recording is a commonly used test. However, there are no clear guidelines on who should be examined using this method, and we lack an overview of the results of testing and their therapeutic implications. MATERIAL AND METHOD: All long-term ECG recordings performed at Sørlandet Hospital Arendal in the period 2017-18 were included in the study. The tests were identified by searching the medical records system for relevant procedure codes, and all medical records related to the test were subsequently reviewed. Patient characteristics, referrer, indication, results, further assessment, and treatment were recorded. RESULTS: A total of 1 262 long-term ECG recordings were performed at Sørlandet Hospital Arendal in the period 2017-18. The median age of those tested was 60 years, and 48 % of tests were performed in women. A total of 253 (20 %) recordings revealed arrhythmias and 168 (13 %) had therapeutic implications. For patients without known heart disease or a history of stroke (n = 619 (49 %)), the test had therapeutic implications in 32 (5 %) cases. INTERPRETATION: Long-term ECG recording was often used to test patient populations with limited cardiac arrhythmia, and the results rarely had therapeutic implications. The findings of the study may indicate that long-term ECG recording should be used to a greater extent in patients for whom positive findings would have therapeutic and prognostic implications, such as those in whom stroke prophylaxis would be indicated if they were found to have atrial fibrillation.

BEtablocker Treatment After acute Myocardial Infarction in revascularized patients without reduced left ventricular ejection fraction (BETAMI): Rationale and design of a prospective, randomized, open, blinded end point study.

BACKGROUND: Current guidelines on the use of ß-blockers in post-acute myocardial infarction (MI) patients without reduced left ventricular ejection fraction (LVEF) are based on studies before the implementation of modern reperfusion and secondary prevention therapies. It remains unknown whether ß-blockers will reduce mortality and recurrent MI in contemporary revascularized post-MI patients without reduced LVEF. DESIGN: BETAMI is a prospective, randomized, open, blinded end point multicenter study in 10,000 MI patients designed to test the superiority of oral ß-blocker therapy compared to no ß-blocker therapy. Patients with LVEF ≥40% following treatment with percutaneous coronary intervention or thrombolysis and/or no clinical signs of heart failure are eligible to participate. The primary end point is a composite of all-cause mortality or recurrent MI obtained from national registries over a mean follow-up period of 3 years. Safety end points include rates of nonfatal MI, all-cause mortality, ventricular arrhythmias, and hospitalizations for heart failure obtained from hospital medical records 30 days after randomization, and from national registries after 6 and 18 months. Key secondary end points include recurrent MI, heart failure, cardiovascular and all-cause mortality, and clinical outcomes linked to ß-blocker therapy including drug adherence, adverse effects, cardiovascular risk factors, psychosocial factors, and health economy. Statistical analyses will be conducted according to the intention-to-treat principle. A prespecified per-protocol analysis (patients truly on ß-blockers or not) will also be conducted. CONCLUSIONS: The results from the BETAMI trial may have the potential of changing current clinical practice for treatment with ß-blockers following MI in patients without reduced LVEF. EudraCT number 2018-000590-75.

Unsatisfactory risk factor control and high rate of new cardiovascular events in patients with myocardial infarction and prior coronary artery disease.

BACKGROUND: Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. An underuse of secondary preventive drugs has been observed, and many patients may not attain the treatment goals for secondary prevention. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD. METHODS: Data concerning all patients with MI admitted to hospitals in Norway from 2013 to 2016 were retrieved from the Norwegian Myocardial Infarction Register (NORMI). Long-term mortality was obtained through linkage with the Norwegian Cause of Death Registry. RESULTS: In total, 47,204 patients were registered in the NORMI from 2013 to 2016. Prior CAD was recorded in 7219 (25.2%) of the 28,607 patients < 80 years old with Type 1 MIs. On average, 3 of the 6 defined treatment targets for secondary preventive therapy were attained, and only 1% of the patients achieved all targets. Patients with MI and prior CAD had increased risk of death or new MI compared to patients without prior CAD during long-term follow-up (adjusted HR 1.6, 95% CI 1.5-1.7). CONCLUSIONS: Prior CAD was frequent in patients with acute MI. The attainment of secondary preventive treatment targets in patients with MI and prior CAD was not optimal, and the long-term outcomes were reduced compared to patients without prior CAD. Increased efforts to improve risk factor control are needed.

Diagnosis of severe congenital heart defects in Norway 2016. / Diagnostikk av alvorlige medfødte hjertefeil i Norge 2016.

BACKGROUND: Most structural congenital heart defects can be identified prenatally through ultrasound examination in pregnancy or via routine examinations during hospital maternity stays, but in some cases, heart defects are not discovered prior to discharge. There has been little previous research into detection rates with the various methods available. In this study, we have examined the timing and method of diagnosis of severe congenital heart defects. MATERIAL AND METHOD: All children with severe heart defects born in Norway in 2016 and registered at Oslo University Hospital were included in this study. In addition, information on committee-handled abortions (after the 12th week of pregnancy) was obtained from the Medical Birth Registry of Norway. RESULTS: In total, 105 of 181 (58 %) severe heart defects were diagnosed prenatally, and 51 (28 %) pregnancies were terminated. Among the 73 live-born children with severe heart defects that went unrecognised prenatally, 33 (45 %) of the heart defects were discovered outside of routine examinations and 9 (12 %) after discharge from hospital. Coarctation of the aorta was the most common diagnosis in cases of late-detected heart defects. INTERPRETATION: This first national study of the diagnosis of severe congenital heart defects in Norway shows that most severe congenital heart defects are discovered prior to discharge from hospital after birth. However, almost half are diagnosed outside of routine examinations, and in some cases the diagnosis is not made until after discharge. The results indicate a need for new studies and for a quality registry of congenital heart defects to further improve diagnosis and early treatment.

Takotsubo syndrome in Sørlandet Hospital Arendal 2010-16. / Takotsubosyndrom ved Sørlandet sykehus Arendal 2010­16.

BAKGRUNN: Takotsubosyndrom er en akutt hjertesykdom med symptomer som ved akutt hjerteinfarkt, men med åpne koronararterier og regionale funksjonsforstyrrelser i venstre ventrikkel. Vi har undersøkt forekomst av og forløp ved tilstanden hos pasienter i Agder og Telemark. MATERIALE OG METODE: Alle pasienter innlagt i Sørlandet sykehus Arendal fra 1. mars 2010 til 31. januar 2016 med diagnosen takotsubosyndrom ble inkludert og fulgt til 15. september 2016. RESULTATER: Totalt ble det inkludert 91 episoder med takotsubosyndrom fordelt på 90 pasienter, hvorav 93 % var kvinner og 88 % var over 60 år. Forekomsten var 3,3 per 100 000 innbyggere per år i perioden og det var 19,9 % årlig økning. Takotsubosyndrom forelå ved 2,3 % av alle undersøkelser med koronar angiografi ved indikasjon akutt hjerteinfarkt. Behandlingstrengende komplikasjoner oppsto ved 39 % av innleggelsene. 7 % av pasientene døde i løpet av oppfølgingstiden (median 985 dager), og 3 % fikk residiv. FORTOLKNING: Takotsubosyndrom er en viktig differensialdiagnose ved mistanke om akutt hjerteinfarkt, spesielt hos eldre kvinner, og det er registrert økende forekomst. Mange pasienter har behandlingstrengende komplikasjoner i akuttfasen. Ventrikkelfunksjonen blir normal i løpet av seks måneder, men residiv kan forekomme.

Prevalence of diabetes before and after first diagnosis of coronary artery disease. / Forekomst av diabetes før og etter første gangs koronarsykdom.

BAKGRUNN: Diabetes er assosiert med koronarsykdom, og kardiovaskulær sykdom er viktigste dødsårsak hos mennesker med sykdommen. I denne studien har vi undersøkt forekomsten av kjent diabetes og ikke-erkjent diabetes hos pasienter ved første gangs hjerteinfarkt, perkutan koronar intervensjon eller koronar bypasskirurgi samt forekomsten av nye kardiovaskulære hendelser i inntil fem år etterpå. MATERIALE OG METODE: Alle pasienter < 80 år uten tidligere kjent koronarsykdom innlagt ved Sørlandet sykehus Arendal i forbindelse med første gangs hjerteinfarkt, perkutan koronar intervensjon eller koronar bypasskirurgi i perioden 2007-16 ble fortløpende inkludert i studien og fulgt i inntil fem år (median oppfølgingstid tre år). RESULTATER: Av totalt 1 259 inkluderte pasienter hadde 178 (14 %) kjent diabetes ved innleggelsestidspunktet og 49 (4 %) ikke-erkjent diabetes. I løpet av oppfølgingsperioden utviklet ytterligere 102 pasienter (8 %) diabetes. Omtrent halvparten av dem med diabetes hadde en HbA1c-verdi ≤ 7 %. Risikoen for utvikling av nye kardiovaskulære hendelser var høyere hos pasienter med diabetes enn hos pasienter uten diabetes (alders- og kjønnsjustert hasardratio 1,5; 95 % konfidensintervall: 1,1-2,1, p = 0,005). FORTOLKNING: Studien viser at det er høy forekomst av diabetes hos pasienter med første gangs koronarsykdom og høy risiko for nye kardiovaskulære hendelser hos pasienter med diabetes. Regelmessig undersøkelse med tanke på utvikling av diabetes og god forebyggende behandling av pasienter med diabetes og koronarsykdom er viktig.

Sudden unexpected death in children with congenital heart defects.

AIMS: Congenital heart defects (CHDs) are the most common birth defects and are an important cause of death in children. The fear of sudden unexpected death has led to restrictions of physical activity and competitive sports. The aim of the present study was to investigate the rate of sudden unexpected deaths unrelated to surgery in children 2-18 years old with CHDs and, secondarily, to determine whether these deaths were related to cardiac disease, comorbidity, or physical activity. METHODS AND RESULTS: To identify children with CHDs and to determine the number of deaths, data concerning all 9 43 871 live births in Norway in 1994-2009 were retrieved from the Medical Birth Registry of Norway, the Cardiovascular Disease in Norway project, the Oslo University Hospital's Clinical Registry for Congenital Heart Defects and the Norwegian Cause of Death Registry. Survivors were followed through 2012, and information for the deceased children was retrieved from medical records at Norwegian hospitals. Among 11 272 children with CHDs, we identified 19 (0.2%) children 2-18 years old who experienced sudden unexpected deaths unrelated to cardiac surgery. A cardiac cause of death was identified in seven of these cases. None of the children died during physical activity, whereas two children survived cardiac arrest during sports. CONCLUSION: Sudden unexpected death was infrequent among children with CHDs who survived 2 years of age. Comorbidity was common among the children who died. This study indicates that sudden unexpected death in children with CHDs rarely occurs during physical activity.

Initiation of and long-term adherence to secondary preventive drugs after acute myocardial infarction.

BACKGROUND: Secondary preventive drug therapy following acute myocardial infarction (AMI) is recommended to reduce the risk of new cardiovascular events. The aim of this nationwide cohort study was to examine the initiation and long-term use of secondary preventive drugs after AMI. METHODS: The prescription of drugs in 42,707 patients < 85 years discharged alive from hospital after AMI in 2009-2013 was retrieved by linkage of the Norwegian Patient Register, the Norwegian Prescription Database, and the Norwegian Cause of Death Registry. Patients were followed for up to 24 months. RESULTS: The majority of patients were discharged on single or dual antiplatelet therapy (91 %), statins (90 %), beta-blockers (82 %), and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor II blockers (ARB) (60 %). Patients not undergoing percutaneous coronary intervention (PCI) (42 %) were less likely to be prescribed secondary preventive drugs compared with patients undergoing PCI. This was particular the case for dual antiplatelet therapy (43 % vs. 87 %). The adherence to prescribed drugs was high: 12 months after index AMI, 84 % of patients were still on aspirin, 84 % on statins, 77 % on beta-blockers and 57 % on ACEI/ARB. Few drug and dose adjustments were made during follow-up. CONCLUSION: Guideline-recommended secondary preventive drugs were prescribed to most patients discharged from hospital after AMI, but the percentage receiving such therapy was significantly lower in non-PCI patients. The long-time adherence was high, but few drug adjustments were performed during follow-up. More attention is needed to secondary preventive drug therapy in AMI patients not undergoing PCI.

Gender differences in the assessment and treatment of myocardial infarction. / Kjønnsforskjeller i utredning og behandling av hjerteinfarkt.

BACKGROUND: Previous studies have shown that there are gender-related differences in the assessment and treatment of myocardial infarction, despite international guidelines that prescribe identical treatment for women and men. We investigated whether these differences occurred in Norway. MATERIAL AND METHOD: All patients admitted to Norwegian hospitals with myocardial infarction from 1 January 2013 to 31 December 2014 and registered in the Norwegian Myocardial Infarction Registry were included. Data from the registry were used to analyse differences in the assessment, treatment, complications and survival of women and men in different age groups. RESULTS: A total of 26 447 myocardial infarctions were registered in the Norwegian Myocardial Infarction Registry in the period 2013 ­ 2014. Fewer women than men were assessed by means of coronary angiography. Percutaneous coronary intervention (PCI) was used to virtually the same extent for both genders if coronary stenosis was found. Women were recommended secondary prophylactic medication to a lesser extent than men. There were no major differences between men and women in the incidence of complications in the course following myocardial infarction or in survival. INTERPRETATION: Fewer women than men suffering acute myocardial infarction were assessed by means of coronary angiography, and women were recommended secondary prophylactic medication less often than men. The reason for the gender differences is not known, but comorbidity and a potentially greater risk of adverse reactions in women may be contributory factors. The different views of doctors providing treatment may also play a part.

Are the guidelines for treatment of myocardial infarction complied with?

BACKGROUND: New guidelines recommend early invasive evaluation and treatment for most patients with acute myocardial infarction--including patients with myocardial infarction without ST elevation in the ECG. This study examines compliance with the new guidelines at Sørlandet Hospital Arendal. MATERIAL AND METHOD: All patients admitted to Sørlandet Hospital Arendal with acute myocardial infarction in 2012 were registered in the Norwegian Myocardial Infarction Register. Data from the register were used to analyse the time that passed from symptom onset to coronary angiography and revascularisation. RESULTS: In 2012, 788 patients were admitted to Sørlandet Hospital Arendal with acute myocardial infarction. Of these, 269 (34.1%) had ST elevation mycardial infarction (STEMI) and 519 (65.9%) had non-ST elevation myocardial infarction (NSTEMI). Most patients with ST elevation infarction (220 (81.8%)) were admitted directly to Sørlandet Hospital Arendal, and the median time from admission to revascularisation was 31 minutes. 347 (66.9%) of the patients with non-ST elevation infarction were first admitted to a local hospital before being transferred to Sørlandet Hospital Arendal. Only four (1.2%) of them underwent angiography within two hours of admission to the first hospital. 13 (9.0%) of the patients with non-ST elevation infarction who were admitted directly and underwent angiography (n = 144) had an angiogram within two hours of admission. Angiography was performed within 24 hours in 119 (34.3%) of those transferred (n = 347) and in 82 (56.9%) of the directly admitted patients who underwent angiography (n = 144). INTERPRETATION: Many patients with non-ST elevation infarction did not receive revascularisation with percutaneous coronary intervention (PCI) within the recommended time frame. Where there is a strong clinical suspicion of acute myocardial infarction, more patients should be admitted directly to hospitals with PCI preparedness.