Association Between Alcohol Consumption and Cardiovascular Risk Based on Data from the Three Generations for Health Program in Hungary.

BACKGROUND Alcohol consumption has a significant effect on cardiovascular health, and risk factors, such as excessive alcohol use, should be avoided. Although alcohol consumption has decreased over the last decade in Hungary, it is still significantly higher than the average across the European Union. The objective of this study was to describe the patterns of alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), with a special focus on cardiovascular risk status (low, moderate, high, or very high). MATERIAL AND METHODS The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of cardiovascular diseases. An ordinal multiple logistic regression analysis was performed with 10 categorical explanatory variables and the outcome was the categorical cardiovascular risk. RESULTS The database consisted of patients aged 40-65 years with a sample size of 11 348. A significant relationship was found between alcohol consumption and cardiovascular risk status; people with high-risk drinking patterns had higher a value of odds ratio (OR=1.306 [1.003-1.701]) for having a more serious cardiovascular status. According to multiple regression analysis, alcohol dependence was associated with cardiovascular risk. CONCLUSIONS From a public health perspective, the results highlight the importance of reducing alcohol consumption with the help of primary care and preventive services in countries with a high cardiovascular risk profile to reduce the cardiovascular disease-related burden.

External validation of the GRACE risk score in patients with myocardial infarction in Hungary.

Background: Literature confirms that the Global Registry of Acute Coronary Events (GRACE) risk score provides a better risk evaluation than clinical judgment in patients with acute myocardial infarction. We aimed to externally validate the GRACE risk score in unselected patients with myocardial infarction in Hungary. Methods: Data from the comprehensive Hungarian Myocardial Infarction Registry (HUMIR), a national registry that collects data on consecutive acute myocardial infarction (AMI) patients, were used. Hospitals registered 102,939 infarction events in the HUMIR between January 1, 2014, and December 31, 2020. The data required to calculate GRACE risk score were available for 75,199 events. We studied the 6-months, 1-year, and 3-year outcomes. We calculated widely used metrics to characterise calibration (calibration curve, calibration intercept and slope, Eavg, Emax, and E90) and discrimination (c-score, equivalent to AUC, and Somer's Dxy). Results: The risk of low-risk patients was underestimated, and the risk of high-risk patients was overestimated. However, the deviation was small, especially for the three-year survival (E90 was 0.15, 0.22, and 0.08). Discrimination was good, with an AUC of approximately 0.8, and was very similar in all the periods. Conclusions: These data confirmed the usefulness of GRACE risk score in selecting high-risk patients with myocardial infarction in the Hungarian population.

[Health status and cardiovascular risk of Roma and non-Roma population in underprivileged settlements]. / Egészségi állapot és cardiovascularis kockázat roma és nem roma populációban hátrányos helyzetu településeken.

INTRODUCTION: The "Taking the screening tests in place" program offers cardiovascular screening activities to the inhabitants of underprivileged settlements. OBJECTIVE: Evaluation of the health status and cardiovascular risk of the Roma and non-Roma population in underprivileged settlements. METHOD: Information was collected about the demography, lifestyle, current illnesses, access to healthcare and the quality of patient information. General health check (body weight, height, blood pressure, blood sugar, ankle-brachial index) and cardiovascular examination were performed. Data were analyzed in Roma and non-Roma groups with Pearson's chi-squared test. RESULTS: 3649 people participated in the study (851 [23%] men, 2798 [77%] women), 16% (598) of the investigated population belonged to the Roma population. The mean age of men in the general population was 58 years and of women 55 years, in the Roma population 48 years and 47 years. People in the Roma population smoked more often (men 45%, women 64%) than people in the general population (both sexes 30%). In the Roma population, the consumption of sugary soft drinks at least four times a week (men 55% vs. women 43%) and the BMI (men 30 vs. 29, woman 29 vs. 28) were significantly higher. In the Roma population, 31% of the men and 13% of the women thought that their health status was bad, while in the general population it was 17% of men and 8% of women. Incidence of COPD (18% vs. 9%), coronary disease (18% vs. 13%), peripheral artery disease (13% vs. 9%) was significantly higher in the Roma population among women. CONCLUSION: In the investigated population, the Roma inhabitants were significantly younger, smoked more, they were more obese, the chronic diseases were more common among them, and they considered their health status worse than the general population. Orv Hetil. 2023; 164(20): 792-799.

Differences between SCORE, Framingham Risk Score, and Estimated Pulse Wave Velocity-Based Vascular Age Calculation Methods Based on Data from the Three Generations Health Program in Hungary.

Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but different methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved in a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV). The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on the SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as <10%, 10-90%, and >90% ePWV values for the participants. In total, 99,231 subjects were involved in the study, and among them, 49,191 patients had hypertension (HT) and 15,921 patients had diabetes (DM). The chronological age of the total population was 54.0 (48.0-60.0) years, while the SCORE and FRS vascular ages were 59.0 (51.0-66.0) and 64.0 (51-80) years, respectively. In the HT patients, the chronological, SCORE, and FRS vascular ages were 57.0 (51.0-62.0), 63.0 (56.0-68.0), and 79.0 (64.0-80.0) years, respectively. In the DM patients, the chronological, SCORE, and FRS vascular ages were 58.0 (52.0-62.0), 63.0 (56.0-68.0), and 80.0 (76.0-80.0) years, respectively. Based on ePWV, the FRS identified patients with an elevated vascular age with high sensitivity (97.3%), while in the case of the SCORE, the sensitivity was much lower (13.3%). In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation in CV preventive strategies requires further studies.

Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2.

OBJECTIVE: Cardiovascular risk estimation is an essential step to reduce the onset of adverse cardiovascular events. For this purpose, the Systematic Coronary Risk Evaluation (SCORE) risk chart method was used in Europe. In 2021, the SCORE2 algorithm was released, bringing changes in the calculation methodology. This study assessed and compared the level of cardiovascular risk in a population aged 40-65 years using the SCORE and SCORE2 methodologies. METHODS: This cross-sectional study included a total of 85 802 patients in Hungary. Cardiovascular risk levels were determined using the SCORE and SCORE2 risk estimation methods. RESULTS: Using SCORE, 97.7% of men aged 40-50 years were classified as low-moderate risk, which decreased to 32.4% using SCORE2. Using SCORE, 100% of women aged 40-50 years were classified as low-moderate risk, compared with 75.6% using SCORE2. Using SCORE, 36.8% of men aged 50-65 years were classified as high risk and 14.8% as very high risk, and 5.4% of women aged 50-65 years were classified as high risk and 0.5% as very high risk. In this age group, using SCORE2, 50% of men were classified as high risk and 25.8% as very high risk, and 38.8% of women were classified as high risk and 11.9% as very high risk. CONCLUSIONS: When the SCORE2 method was used instead of SCORE 43.91% of the whole population were classified with a higher level of risk, which represents a radical increase in the number of patients with high or very high cardiovascular risk.

[Comparison of the incidence, treatment and prognosis of myocardial infarction in Hungary's differently developed districts]. / A szívinfarktus incidenciája, a betegek ellátásának és prognózisának összehasonlítása Magyarország különbözo fejlettségu járásaiban.

INTRODUCTION: Several international studies have already confirmed the importance of the socioeconomic status of acute myocardial infarction patients in terms of patient care and prognosis. To our knowledge, a nationwide examination of this kind has not yet taken place in Hungary. The investigation of this problem field was made possible by the fact that from January 1, 2014, all healthcare providers must record the data of patients treated with a diagnosis of acute myocardial infarction in the database of the Hungarian Myocardial Infarction Registry (HUMIR). OBJECTIVE: In this study, the authors searched for an answer to whether the complex development index (CDI) in Hungary's 174 districts and 23 capital districts influences the treatment and prognosis of acute myocardial infarction patients. METHOD: Based on the CDI worked out by the Hungarian Central Statistical Office, the authors divided the Hungarian districts into low (CDI_L), medium (CDI_M) and high (CDI_H) CDI groups according to their values. They examined the incidence, hospital treatment and prognosis of acute myocardial infarction in these administrative-territorial units. The HUMIR included 66,253 patients treated by myocardial infarction between 2015 and 2019. Their place of residence could be identified based on the zip code and in which district it was located. In the examined population, 29,101 patients with ST-elevation (STEMI) and 37,152 without ST-elevation (NSTEMI) received treatment for acute myocardial infarction. RESULTS: In the population over 15 years of age, the age-standardized incidence of STEMI was 68.8 per 100,000 inhabitants a year in the CDI_L group and 52.7 per 100,000 inhabitants a year in the CDI_H group. Almost the same values were found in all three CDI subgroups of NSTEMI incidence (69.5 and 67 per 10,000 inhabitants a year). The frequency of percutaneous coronary intervention in the case of STEMI was higher than in NSTEMI, but within the groups, CDI did not influence the performance of this treatment. In the case of STEMI, the rates of patients who underwent percutaneous coronaria intervention in all three CDI subgroups (CDI_L, CDI_M, CDI_H) were 83.5%, 83.7%, 83.5%, while in the case of NSTEMI they were 57.4%, 57.7%, 57.3%. The authors applied a Cox multivariate regression analysis to examine myocardial infarction mortality. The CDI did not affect the 30-day mortality rates in the case of any myocardial infarction: the hazard ratio (HR) values were 0.906 and 0.914 (p = 0.04659; p = 0.04686) in the case of STEMI, while 1.067 and 1.001 (p = 0.16520; p = 0.98933) in the case of NSTEMI. In the case of a STEMI diagnosis, the risk of the 30-364-day and the 1-year mortality in the subgroup of CDI_H was significantly lower (HR = 0.822 and 0.816) than in the subgroup of CDI_L (p = 0.00096 and p = 0.00001). In the case of NSTEMI diagnosis, the authors found a difference in the risk of beyond 1-year mortality by comparing the districts in the subgroup of CDI_L with the districts in CDI_H: in the latter case, the HR of the mortality was 0.876, which was significantly lower (p = 0.00029) than in the subgroup of CDI_L. CONCLUSION: The CDI has independent prognostic significance in determining the late prognosis of acute myocardial infarction patients. Orv Hetil. 2022; 163(47): 1862-1871.

Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary.

BACKGROUND: The management of risk factors in patients with high cardiovascular risk and its effectiveness is of paramount importance. Over the last decade, several studies have examined the achievement of cardiovascular risk factors' target levels in Europe. In the present Hungarian study, we assessed the cardiovascular risk level of participants aged 40-65 years and the success of achieving risk factors' target levels in high- and very high-risk patients. We compared these results with the results of two similar European studies. METHODS: We conducted a cross-sectional study involving 37,778 patients aged 40-65 years from Hungary between 2019 and 2020. Cardiovascular risk levels and target values were set according to the 2016 European Guideline. Target achievement was evaluated for body mass index, waist circumference, blood pressure, total, LDL, and HDL cholesterol, triglyceride, and HbA1c (in diabetics). RESULTS: For 37,298 patients, all the data were available to determine their cardiovascular risk category. Of these, 23.1% had high and 31.4% had very high cardiovascular risk (men: 27.1 and 39.6%, women: 20.5 and 26.1%, respectively). Achievement of the LDL-C target of 1.8 mmol/l was only 8.0% among very high-risk patients, which was significantly lower than the European average (29%). Achievement of target blood pressure among high-risk patients was better than the European average (63.4% vs. 44.7%, respectively); however, achievement was slightly lower among very high-risk patients compared with the European average (49.4% vs. 58%, respectively). The proportion of patients with type 2 diabetes who achieved a HbA1c below 7% was 57.3% in the high-risk population and 53% in the very high-risk population, which was in line with the European average success rates (58.5 and 54%, respectively). Waist circumference (< 88 cm for women and < 102 cm for men) was achieved by 29.4% of patients in the very high-risk group in our survey, which was lower than the European average of 41%. CONCLUSIONS: The success rate of cardiovascular risk management in Hungary is lower than the European average in several parameters. Furthermore, our data highlight the poor effectiveness of obesity management in Hungary. General practice partnerships may be important sites for positive change.

[Investigating cognitive impairment in communities of practice - lessons learned]. / Kognitív funkcióromlás vizsgálata praxisközösségekben ­ tanulságok.

Background and purpose: In the "Three Generations for Health" programme, general practitioners were responsible for screening for dementia in their practices using mini-COG and Mini Mental State Examination. The aim was to present the screening results of those included, their assessment by the doctor and the further fate of the patients. Methods: After mini-COG test, MMSE test was performed in case of suspected dementia. The examiner categorized the result as abnormal or no abnormal, recorded the referral, and recorded the data in an online interface. Our study is a cross-sectional study; the evolution and distribution of the parameters described in the objectives are described with raw case numbers and proportions. Patients aged 55 years and over were recruited consecutively. Only those cases (29 730) where mini-COG and MMSE test results were available, their assessment by the physician, and referral data to specialist care were analyzed. Results: The Mini-COG test revealed that 64% of the subjects were suspected of cognitive decline. Misclassification occurred in 13 015 cases, with 21% of the Mini-Cog test scores matching cognitive decline and 21% of lesions considered abnormal by GPs. The MMSE test raised the suspicion of dementia in 34% of the sample (10 174 people), with 4 262 (42%) of the participating GPs considering the result abnormal. 11% (2095 people) of people with abnormal Mini-Cog test scores and 17% (1709 people) of people with suspected dementia based on MMSE test scores were referred to specialist care. Conclusion: Our study assessed the practice of detecting cognitive decline in primary health care. The tools adopted for screening for dementia were used by practices, but the assessment of results and referral of suspected cases of dementia to specialist care were below the expected level. There is a need to improve primary care providers' knowledge of dementia detection and treatment and to strengthen links with specialist care.

Practice of antiplatelet therapy in acute myocardial infarction / A thrombocytaaggregáció-gátló kezelés gyakorlata heveny szívinfarktusban

Introduction: In patients who have survived myocardial infarction, platelet aggregation inhibitor (TAG) treatment plays an important role in preventing recurrent ischemic events. Objective: to investigate the proportion of patients who received aspirin, clopidogrel, prasugrel and ticagrelor during the hospitalization and the proportion of patients who continued taking the recommended therapy during follow-up. All patients treated for myocardial infarction who had a medical ID number were included in the study. Results: 16 273 patients had ST-elevation (STEMI) and 20 305 patients had non-ST-elevation (NSTEMI) infarction. 80% of patients were hypertensive. Diabetes mellitus (35%) and impaired renal function (30%) were demonstrated in one in three patients. The TAG treatment recommendation was analysed in 36 578 patients who left the hospital. Clopidogrel 12.7%, prasugrel 4.3%, ticagrelor, 93.9%, 77.7%, 8.3% and 3.2% were found in the NSTEMI group. For medicines available under special conditions (prasugrel, ticagrelor), there were significant differences between cen­tres: the proposal varied between 1.2­4.3% for prasugrel and 0.3­10.8% for ticagrelor. Drug switching events were monitored using the National Institute of Health Insurance Fund database. Pharmacovigilance data were available for 29 405 patients. We considered the longest period in the adherence study, and the grace period was 2 months. Adherence durations were processed using a standard survival analysis toolkit (Kaplan­Meier method). At 1 year after the first switch, 76.1%, 78.3%, and 80.9% of the patients in clopidogrel, prasugrel and ticagrelor were adherents to the recommended treatment. Conclusion: The frequency of use of certain antiplatelet drugs varies significantly across different intervention centres. More than three-quarters of the patients are adherent to treatment 1 year after starting treatment.

Cost-effectiveness of introducing licensed GP practices to manage diabetes patients in Hungary.

AIM: To investigate the cost-effectiveness of the endowment of the same authority and responsibility in diabetes management to licensed GPs as licensed outpatient specialists in Hungary. METHODS: The Syreon Diabetes Control Model (SDM) was used to evaluate life expectancy, quality-adjusted life expectancy (QALY) and direct medical costs over patient lifetimes. Cohort characteristics were derived from national database, clinical history data of 476,211 persons with diabetes were used, treatment effects and costs were derived from literature, national databases and expert opinions. RESULTS: The purchase of one additional quality adjusted life year with the use of licensed general practitioners was EUR 51,420 compared to making the service available only through universal GPs. The purchase of one additional quality adjusted life year through the service of licensed GPs is EUR 459,950 compared to outpatient care provision. CONCLUSIONS: The management of diabetes care with licensed GPs has the potential to improve patients health gains compared to the current patterns of care in Hungary in a cost-effective way if licensed GPs are reimbursed below the average current cost of outpatient diabetes services. Increase of the capitation for diabetic patients would be a practical way to reimburse the GP's additional service.

[Pneumococcal vaccination in general practice]. / A pneumococcusvakcináció gyakorlata a családorvosi praxisokban.

INTRODUCTION: The prevalence of invasive pneumococcal disease, which is depending on risk factors and comorbidities, is increasing over the age of 50 years. Most developed countries have recommendations but vaccination rates remain low. AIM: To assess the general practitioners' daily practice in relation to pneumococcal vaccination and analyse the effect of informing the subjects about the importance of pneumococcal vaccination on vaccination routine. METHOD: Subjects over 50 years of age vaccinated against influenza during the 2012/2013 campaign were informed about the importance of pneumococcal vaccination and asked to fill in a questionnaire. RESULTS: Of the 4000 subjects, 576 asked for a prescription of pneumococcal vaccine (16.5% of females and 11.6% of males, OR 1.67 CI 95% 1.37-2.04, p<0.001) and 310 were vaccinated. The mean age of females and males was 70.95 and 69.8 years, respectively (OR 1.01; CI 95% 1.00-1.02; p<0.05). Information given by physicians resulted in 33,6% prescription rate, while in case it was 8% when nurses provided information (OR 6.33; CI 95% 5.23-7.67; p<0.001). As an effect of this study the vaccination rate was 6.3 times higher than in the previous year campaign (p<0.001). CONCLUSIONS: General practitioners are more effective in informing subjects about the importance of vaccination than nurses. Campaign can raise the vaccination rate significantly.

Psychometric properties and construct validity of the brief Wisconsin inventory of smoking dependence motives in an Internet-based sample of treatment-seeking Hungarian smokers.

INTRODUCTION: Both full and brief versions of the Wisconsin Inventory of Smoking Dependence are promising new measurement tools for studying tobacco dependence. We assessed the psychometric properties and construct validity of the Wisconsin Inventory of Smoking Dependence Motives (WISDM)-68 and WISDM-37. METHODS: Participants were adult, treatment-seeking Hungarian daily smokers (N = 720) with Internet access who were also registered on a smoking cessation Web site. Using confirmatory factor analyses (CFAs), we tested the measurement models of both WISDM-68 and WISDM-37, internal consistency of subscales of WISDM-37, and gender invariance. We tested the associations between heaviness of smoking, tobacco dependence symptoms, smoking environment, and subscales of WISDM-37. RESULTS: Although the measurement model of WISDM-68 did not fit adequately, the measurement model of WISDM-37, including 11 correlating factors (affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, cue exposure/associative processes, social/environmental goads, taste, tolerance, weight control, affective enhancement), satisfactorily represents the data. Latent structures are equal in both genders. Internal consistency of subscales of WISDM-37 ranges between 0.67 and 0.90. Tobacco dependence symptoms were significantly linked with all motives, heaviness of smoking was related significantly only to affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, and tolerance, while tobacco dependence symptoms and gender were controlled. Gender was associated only with the weight control motive. CONCLUSIONS: Concurring with previous reports using other types of sample, WISDM-37 has sufficient psychometric properties and good construct validity to make it useful in measuring the multidimensional nature of tobacco dependence even in Internet-based research. Without precedent, gender equality of WISDM-37 is also supported.

Comparative analysis of diagnostic probability estimates of some common diagnoses among family doctors, medical residents, and medical students reveals negative correlation between age and estimate of chronic obstructive pulmonary disease (COPD).

BACKGROUND: Patients with their given complaints and symptoms expect certain diagnoses to be estimated with the same probability when seen by different family doctors. These estimations showed extreme variation among family doctors in Switzerland. The present study investigated whether there is any difference in the probabilities of the same diagnoses given by Hungarian doctors and, if so, what the responsible factors are. Estimates given by specialists, residents of family medicine, and medical students were also compared. MATERIAL/METHODS: In this cross-sectional study, 484 family physicians, 124 medical residents, and 148 medical students completed a questionnaire that assessed the diagnostic probability of six clinical scenarios. RESULTS: Medians and ranges of probability were almost the same in both countries. Significant negative correlation was observed between age and the estimation of COPD among the family physicians (Spearman's r=-0.231, p<0.001). This correlation was even more expressed in men and was independent of gender, previous specialization in internal medicine or pulmonology, and the location of practice. Family physicians rated the probability of myocardial infarction higher than the residents (p<0.01). They also rated the probability of congestive heart disease higher than the medical students (p<0.001). Women residents and students gave higher estimates in almost all clinical settings than did men. CONCLUSIONS: Diagnostic estimates of the same clinical scenarios vary widely among Hungarian family doctors, residents, and medical students. The independent inverse relationship between the doctor's age and his/her estimate of the probability of COPD underscores the need to intensify education on this disease.