RESUMO
BACKGROUND: The time lapse between onset of symptoms and a call to an emergency dispatch center (pain-to-call time) is a critical prognostic factor in patients with chest pain. It is therefore important to identify factors related to delays in calling for help. OBJECTIVES: To analyze whether age, gender, or time of day influence the pain-to-call delay in patients with acute STsegment elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Data were extracted from a prospective registry of STEMI cases managed by 39 mobile intensive care ambulance teams before hospital arrival within 24 hours of onset in our region, the greater metropolitan area of Paris, France. We analyzed the relation between pain-to-call time and the following factors: age, gender, and the time of day when symptoms appeared. We also assessed the influence of pain-to-call time on the rate of prehospital decisions to implement reperfusion therapy. RESULTS: A total of 24 662 consecutive patients were included; 19 291 (78%) were men and 4371 (22%) were women. The median age was 61 (interquartile range, 52-73) years (men, 59 [51-69] years; women, 73 [59-83] years; P .0001). The median pain-to-call time was 60 (24-164) minutes (men, 55 [23-150] minutes; women, 79 [31-220] minutes; P .0001). The delay varied by time of day from a median of 40 (17-101) minutes in men between 5 pm and 6 pm to 149 (43-377) minutes in women between 2 am and 3 am. The delay was longer in women regardless of time of day and increased significantly with age in both men and women (P .001). A longer pain-to-call time was significantly associated with a lower rate of implementation of myocardial reperfusion (P .001). CONCLUSION: Pain-to-call delays were longer in women and older patients, especially at night. These age and gender differences identify groups that would benefit most from health education interventions.
INTRODUCCION: En el dolor torácico, el tiempo desde el inicio de los síntomas hasta el aviso al sistema de emergencias (TAE) es un factor pronóstico decisivo. Es necesario conocer los factores que pueden influir en su duración. OBJETIVO: Analizar el efecto de la edad, el sexo y el momento del día en el TAE en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMEST). METODO: Se analizaron los datos de un registro regional prospectivo que incluye a todos los pacientes con IAMEST y 24 horas de evolución atendidos por 39 equipos de ambulancias de soporte vital avanzado en un entorno prehospitalario en el área metropolitana de París, Francia. Se analizó el TAE en relación con la edad, el sexo y el momento de aparición de los síntomas. Se valoró la influencia del TAE en la decisión prehospitalaria de tratamiento de reperfusión. RESULTADOS: Se incluyeron 24.662 pacientes consecutivos, de los cuales 19.291 (78%) eran hombres; la edad mediana fue de 61 años (RIC 52-73); 59 (51-69) en hombres y 73 (59-83) en mujeres (p 0,0001). El TAE fue de 60 minutos (24-164); 55 (23-150) minutos en hombres y 79 (31-220) minutos en mujeres (p 0,0001), y oscilaba entre 40 (17-101) minutos en hombres entre las 17:00 y las 18:00 y 149 (43-377) en mujeres entre las 02:00 y las 03:00. Independientemente de la hora de aparición del dolor, el TAE fue mayor en mujeres, y aumentó con la edad, tanto en hombres como en mujeres (p 0,001). El TAE prolongado se asoció con un descenso significativo en la decisión prehospitalaria de tratamiento de reperfusión (p 0,001). CONCLUSIONES: El intervalo de TAE fue más largo en mujeres y pacientes mayores, especialmente por la noche. Estos resultados permiten identificar los grupos de pacientes que más se beneficiarían de medidas de educación sanitaria.
Assuntos
Fatores Etários , Serviços Médicos de Emergência , Comportamento de Busca de Ajuda , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Feminino , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/estatística & dados numéricos , Paris/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapiaRESUMO
BACKGROUND: One of the modifiable risk factors for ST elevation myocardial infarction is prehospital delay. The purpose of our study was to look at the effect of contamination contamination obsession on prehospital delay compared with other measurements during the Covid-19 pandemic. METHOD: A total of 139 patients with acute STEMI admitted to our heart center from 20 March 2020 to 20 June 2020 were included in this study. If the time interval between the estimated onset of symptoms and admission to the emergency room was >120 min, it was considered as a prehospital delay. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and Padua Inventory-Washington State University Revision (PI-WSUR) test were used to assess Contamination-Obbsessive compulsive disorder (C-OCD). RESULT: The same period STEMI count compared to the previous year decreased 25%. The duration of symptoms onset to hospital admission was longer in the first month compared to second and third months (180 (120-360), 120 (60-180), and 105 (60-180), respectively; P = 0.012). Multivariable logistic regression (model-2) was used to examine the association between 7 candidate predictors (age, gender, diabetes mellitus (DM), hypertension, smoking, pain-onset time, and coronary artery disease (CAD) history), PI-WSUR C-OCD, and admission month with prehospital delay. Among variables, PI-WSUR C-OCD and admission month were independently associated with prehospital delay (OR 5.36 (2.11-13.61) (P = 0.01); 0.26 (0.09-0.87) p < 0.001] respectively]. CONCLUSION: Our study confirmed that contamination obsession was associated with prehospital delay of STEMI patients, however anxiety and depression level was not associated during the pandemic.
Assuntos
COVID-19/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Serviço Hospitalar de Emergência , Comportamento Obsessivo , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Tempo para o Tratamento , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de TempoRESUMO
OBJECTIVE: Delirium is a frequently encountered clinical condition in hospitalized patients and is known to be associated with poor outcomes. This study aims to assess the impacts of delirium in elderly patients undergoing percutaneous coronary intervention (PCI) following ST-elevation myocardial infarction (STEMI). METHODS: We queried the National Inpatient Samples from 2010 to 2014 to identify all patients aged 65 and older, and admitted with a primary diagnosis of STEMI undergoing PCI by using the International Classification of Diseases-Ninth Edition-Clinical Modification diagnosis codes. The patients with delirium from this cohort were further evaluated. Multivariate regression model with SPSS Statistics 25.0 (IBM Corp., Armonk, New York, USA) was used to study the association between delirium and clinical outcomes including in-hospital mortality and length of stay (LOS). RESULTS: Out of weighted 42 980 patients aged ≥65 years with STEMI and PCI, delirium was present in 774 patients, accounting for 1.8% of this cohort. These patients were found to be older and had more underlying co-morbidities, compared to those without delirium [Median Charlson score 2 (1; 3) vs. 0 (0; 2); P < 0.001]. In-hospital mortality in STEMI patients with delirium was significantly higher than those without delirium [42.7% vs. 7.6%; unadjusted odds ratio (OR) 9.07; 95% confidence interval (CI) 6.55-12.57; P < 0.001; adjusted OR 1.86; 95% CI 1.13-3.04; P = 0.014]. CONCLUSION: Older age and comorbidities are known predisposing factors for delirium, which is in turn associated with higher in-hospital mortality and increased LOS in elderly patients with STEMI who undergo PCI. This study underscores the role of delirium and implicates the importance of further studies in recognition and targeted care of delirium.
Assuntos
Delírio , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias , Infarto do Miocárdio com Supradesnível do Segmento ST , Fatores Etários , Idoso , Comorbidade , Bases de Dados Factuais/estatística & dados numéricos , Delírio/diagnóstico , Delírio/etiologia , Delírio/mortalidade , Delírio/fisiopatologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Mortalidade , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/psicologia , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Stress is known to be a significant risk factor for coronary atherosclerosis and adverse cardiovascular events; however, the stress-related coronary atherosclerotic burden has not yet been investigated. The aim of this study was to investigate the relationship between the Perceived Stress Scale (PSS) and the SYNTAX scores in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 440 patients with STEMI were prospectively enrolled and divided into 2 groups according to the PSS score with a ROC curve analysis cut-off value of 17.5. In all, 361 patients with a low PSS score were categorized as Group 1 and 79 patients with a high PSS score were categorized as Group 2. RESULTS: The SYNTAX score [Group 1, 16.0 (10.0-22.5); Group 2, 22.5 (15.0-25.5); p<0.001] and the SYNTAX score II were significantly higher in Group 2 [Group 1, 24.8 (19.0-32.6); Group 2, 30.9 (22.3-38.9); p<0.001]. Spearman analysis demonstrated that the PSS score was associated with the SYNTAX score (r=0.153; p=0.001) and the SYNTAX score II (r=0.216; p<0.001). Additionally, the PSS (odds ratio: 2.434, confidence interval: 1.446-4.096; p=0.001) was determined to be an independent predictor of a moderate-to-high SYNTAX score. The PSS score of patients with in-hospital mortality was also higher than those who survived [15 (10-20); 9 (4-16), respectively; p=0.007]. CONCLUSION: Stress appears to accelerate the coronary atherosclerotic process and the associated burden. An increased stress level was found to be an independent predictor of a high SYNTAX score.
Assuntos
Doença da Artéria Coronariana/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Índice de Gravidade de Doença , Estresse Psicológico/psicologia , Aterosclerose/psicologia , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/mortalidade , Métodos Epidemiológicos , Feminino , Inquéritos Epidemiológicos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Estresse Psicológico/sangue , Estresse Psicológico/complicações , Estresse Psicológico/diagnósticoRESUMO
OBJECTIVE: We aimed to assess the patient experience of informed consent (IC) during acute myocardial infarction (AMI) in a sub-study of the VALIDATE-SWEDEHEART trial. The original trial compared two anticoagulant agents in patients undergoing coronary intervention. A witnessed oral IC was required prior to randomization in patients with ST-segment elevation myocardial infarction, which was subsequently complemented with a written IC after percutaneous coronary intervention. Written consent was obtained before angiography in patients with non-ST-segment elevation myocardial infarction. BACKGROUND: The IC process in patients with AMI is under debate. Earlier trials in this population have required prospective consent before randomization. A trial published some years ago used deferred consent, but the patient experience of this process is poorly studied. METHODS: A total of 414 patients who participated in the main trial were enrolled and asked the following questions: (1) Do you remember being asked to participate in a study? (2) How was your experience of being asked to participate; do you remember it being positive or negative? (3) Would you have liked more information about the study? (4) Do you think it would have been better if you were included in the study without being informed until a later time? RESULTS: Of these patients, 94% remembered being included; 85% of them experienced this positively, 12% were neutral and 3% negative. Regarding more information, 88% did not want further information, and 68% expressed that they wanted to be consulted before inclusion. Of the patients, 5% thought it would have been better to have study inclusion without consent, and 27% considered it of no importance. CONCLUSION: It is reasonable to ask patients for verbal IC in the acute phase of AMI. Most patients felt positively about being asked to participate and had knowledge of being enrolled in a scientific study. In addition they objected to providing IC after randomization and treatment. TRIAL REGISTRATION: VALIDATE-SWEDEHEART European Union Clinical Trials Register: 2012-005260-10. ClinicalTrials.gov: NCT02311231. Registered on 8 Dec 2014.
Assuntos
Consentimento Livre e Esclarecido , Satisfação do Paciente/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Doença Aguda , Idoso , Anticoagulantes/uso terapêutico , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
AIMS: To evaluate the association of limited English proficiency (LEP) with reperfusion times and outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: This cohort study included 5385 patients who underwent PPCI in 2013-2017 and were prospectively enrolled in the Victorian Cardiac Outcomes Registry. Data linkage to government administrative datasets was performed to identify patients' preferred spoken language, socioeconomic status, and ambulance utilization data. Patients who had a preferred spoken language other than English were defined as having LEP. Of the study cohort, 430 patients (8.0%) had LEP. They had longer mean symptom-to-door time (STDT) [164 (95% confidence interval, CI 149-181) vs. 136 (95% CI 132-140) min, P < 0.001] but similar mean door-to-balloon time [79 (95% CI 72-87) vs. 76 (95% CI 74-78) min, P = 0.41]. They also had higher major adverse cardiovascular and cerebrovascular events (MACCE; 13.5% vs. 9.9%; P = 0.02), severe left ventricular dysfunction (11.0% vs. 8.4%, P = 0.02), and heart failure (HF) hospitalizations within 30 days of PPCI (5.1% vs. 2.0%, P < 0.001). On multivariable analysis, LEP did not independently predict 30-day MACCE [odds ratio (OR) 1.16, 95% CI 0.79-1.69; P = 0.45] but was an independent predictor of both prolonged STDT ≥ 120 min (OR 1.25, 95% CI 1.02-1.52; P = 0.03) and 30-day HF hospitalizations (OR 2.01, 95% CI 1.21-3.36; P = 0.008). CONCLUSION: Patients with LEP undergoing PPCI present later and are more likely to have HF readmissions within 30 days of percutaneous coronary intervention, but with similar short-term MACCE. More effort to provide education in varied languages on early presentation in STEMI is required.
Assuntos
Proficiência Limitada em Inglês , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Tempo para o Tratamento , Resultado do Tratamento , Vitória/epidemiologiaRESUMO
BACKGROUND: Cardiovascular diseases remain the top global killer, with nearly 80% of related mortalities occurring in developing countries. Over half of cardiovascular diseases' mortality is due to coronary heart disease, which is commonly linked to acute myocardial infarction. Psychological factors (i.e., depression and anxiety) after acute myocardial infarction are associated with higher levels of complications and mortality. Perceived control moderated the effect of anxiety on complications in different cardiac populations, but impacts on depression and complications after acute myocardial infarction are not well studied. This study explores the moderating effect of perceived control on the relationship between depression and complications after ST segment elevation myocardial infarction. METHODS: Three hundred patients with a confirmed diagnosis of ST segment elevation myocardial infarction participated in this prospective observational study. Patients answered socio-demographic data, the depression subscale of the Hospital Anxiety and Depression Scale (HADS), and the Control Attitude Scale-Revised (CAS-R) questionnaires. In-hospital complications and all other necessary data were extracted from medical records after discharge. Data were analyzed using logistic regression. RESULTS: 24% developed at least one complication. Patients with high depression scores (8-21) were more likely to develop complications (χ2 = 34.15, p < .001) than those with low depression scores (0-7). Patients with high levels of perceived control had lower levels of depression than those with low perceived control (mean [SD], 9.47 [6.43] vs. 12.31 [6.66], p < .001). The results of logistic regression showed that perceived control moderated the association between depression and complications, since depression scores, perceived control scores, and the interaction between depression and perceived control were significant predictors of complications. Participants with high depression and low perceived control had the highest rate of complications (31.5% vs. 15.4%, P < .001). CONCLUSIONS: Depression increased complications after ST segment elevation myocardial infarction. Perceived control moderated this relationship. Assessment of depression and enhancement of perceived control in patients with acute myocardial infarction can decrease complications and improve outcomes.
Assuntos
Afeto , Depressão/psicologia , Hospitalização , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Autocontrole , Idoso , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/terapia , Feminino , Humanos , Jordânia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapiaAssuntos
Atitude , Participação do Paciente/psicologia , Intervenção Coronária Percutânea/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Tomada de Decisões , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tamanho da Amostra , Inquéritos e Questionários/estatística & dados numéricosRESUMO
OBJECTIVES: Compare gender disparities in ST-elevation myocardial infarction (STEMI) regarding first medical contact (FMC) and prehospital delay times and explore factors associated with prehospital delay in men and women separately. DESIGN: Cross-sectional study based on medical records and a validated questionnaire. Eligible patients were enrolled within 24 hours after admittance to hospital. SETTING: Patients were included from November 2012 to January 2014 from five Swedish hospitals with catheterisation facilities 24/7. PARTICIPANTS: 340 men and 109 women aged between 31 and 95 years completed the survey. MAIN OUTCOME MEASURES: FMC were divided into five possible contacts: primary healthcare centre by phone or directly, national advisory nurse by phone, emergency medical services (EMS) and emergency room directly. Two parts of prehospital delay times were studied: time from symptom onset to FMC and time from symptom onset to diagnostic ECG. RESULTS: Women more often called an advisory nurse as FMC (28% vs 18%, p=0.02). They had a longer delay until FMC, 90 (IQR 39-221) vs 66 (28-161) min, p=0.04 and until ECG, 146 (68-316) vs 103 (61-221) min, p=0.03. Men went to hospital because of believing they were stricken by an MI to a higher extent than women did (25% vs 15%, p=0.04) and were more often recommended to call EMS by bystanders (38% vs 22%, p<0.01). Hesitating about going to hospital and experiencing pain in the stomach/back/shoulders were factors associated with longer delays in women. Believing the symptoms would disappear or interpreting them as nothing serious were corresponding factors in men. In both genders bystanders acting by contacting EMS explained shorter prehospital delays. CONCLUSIONS: In STEMI, women differed from men in FMC and they had longer delays. This was partly due to atypical symptoms and a longer decision time. Bystanders acted more promptly when men than when women fell ill. Public knowledge of MI symptoms, and how to act properly, still seems insufficient.
Assuntos
Disparidades nos Níveis de Saúde , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Tempo para o Tratamento , Idoso , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Autorrelato , Fatores Sexuais , SuéciaRESUMO
BACKGROUND: Anxiety and sleep disorders are prevalent problems in patients presenting with ST-segment-elevation myocardial infarction (STEMI). Usually, these problems are managed by benzodiazepines, which-albeit effective-could cause adverse effects and drug interaction. OBJECTIVE: This study was designed to compare the effects of melatonin and oxazepam in the management of anxiety and insomnia on patients following primary percutaneous coronary intervention (PCI) with a view to providing a safer alternative. METHODS: This study was designed as a randomized clinical trial. STEMI patients managed with primary PCI were enrolled and randomized into 2 groups through the permuted block randomization. The patients received either oxazepam (10 mg) or melatonin (3 mg) every night. Autoimmune disease or previous use of psychoactive medications was considered the exclusion criterion. Levels of anxiety and sleep quality were evaluated using the Hamilton Anxiety Rating Scale (HAM-A) and the Groningen Sleep Quality Score and compared between the groups. RESULTS: Each group contained 20 patients. Melatonin showed a significant advantage over oxazepam in improving sleep quality ( P = 0.040). Comparisons of the efficacy of both medications in lowering the anxiety levels when considering all the items of the HAM-A, including those related to cardiovascular disease, were significantly in favor of melatonin ( P = 0.019). CONCLUSIONS AND RELEVANCE: The results of this study suggest that melatonin, a drug with more favorable drug interaction and adverse effect profile, could be more effective than oxazepam in improving the sleep quality and anxiety levels of patients presenting with STEMI, and it could be considered a new alternative to benzodiazepines in this setting.
Assuntos
Ansiedade/tratamento farmacológico , Melatonina/uso terapêutico , Oxazepam/uso terapêutico , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Sono/efeitos dos fármacos , Idoso , Ansiedade/complicações , Terapia Combinada , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Sono/fisiologia , Resultado do TratamentoRESUMO
Depression and anxiety are common among patients who have a major cardiovascular event. However, despite their frequency, there is a lack of evidence regarding the relationship between depression and/or anxiety and receiving revascularization in ST-elevation myocardial infarction (STEMI) hospitalizations. Using data from the Nationwide Inpatient Sample (NIS) from the years 2004 to 2013, we assessed whether a clinical co-diagnosis of depression and/or anxiety decreases the likelihood of revascularization among STEMI hospitalizations. Our central finding is that, paradoxically, the odds of in-hospital mortality were lower among STEMI hospitalizations with a clinical co-diagnosis of depression and/or anxiety as compared to those without. We further discovered that clinical diagnoses of depression and/or anxiety were less prevalent among revascularized as compared to non-revascularized STEMI hospitalizations. However, the percentage of clinical diagnoses of depression and/or anxiety among STEMI hospitalizations increased at a similar rate over a 10-year period irrespective of revascularization status. In conclusion, these results are suggestive of the potentially underdiagnosed mental health issues surrounding major cardiovascular events, and indeed, chronic disease as a whole. To our knowledge, this is the first study to document and examine the "depression paradox" among a population of cardiac patients.
Assuntos
Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Hospitalização/estatística & dados numéricos , Pacientes Internados/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Idoso , Ansiedade/etiologia , Transtorno Depressivo/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidadeRESUMO
BACKGROUND: The association between diagnosed acute ST-elevation myocardial infarction (STEMI) and hockey games in the Canadian population is unknown. METHODS: We retrospectively analyzed the association between hockey games of the National Hockey League Montreal Canadiens and daily hospital admissions for acute STEMI at the Montreal Heart Institute, Canada. RESULTS: Between June 2010 and December 2014, a total of 2199 patients (25.9% women; mean age, 62.6 ± 12.4 years) were admitted for acute STEMI. An increase in STEMI admissions was observed the day after a hockey game of the Montreal Canadiens in the overall population (from 1.3 ± 1.2 to 1.5 ± 1.3), however, this difference was not significant (P = 0.1). The number of STEMI admissions increased significantly from 0.9 ± 1.0 to 1.2 ± 1.0 per day in men (P = 0.04), but not in women (P = 0.7). The association between ice hockey matches and STEMI admission rates was strongest after a victory of the Montreal Canadiens. Accordingly, an increased risk for the occurrence of STEMI was observed in the overall population (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.0-1.3; P = 0.037) when the Montreal Canadiens won a match. This association was present in men (HR, 1.2; 95% CI, 1.03-1.4; P = 0.02) but not in women (P = 0.87), with a most pronounced effect seen in younger men (younger than 55 years; HR, 1.4; 95% CI, 1.1-1.8; P = 0.009). CONCLUSIONS: Although a weak association between hockey games and hospital admissions for STEMI was found in our overall population, the event of a hockey game significantly increased the risk for STEMI in younger men. Preventive measures targeting behavioural changes could positively affect this risk.
Assuntos
Angiografia Coronária , Hóquei/psicologia , Hospitalização/estatística & dados numéricos , Revascularização Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST , Estresse Psicológico , Fatores Etários , Idoso , Canadá/epidemiologia , Angiografia Coronária/métodos , Angiografia Coronária/estatística & dados numéricos , Correlação de Dados , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Revascularização Miocárdica/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores Sexuais , Comportamento Social , Estresse Psicológico/etiologia , Estresse Psicológico/fisiopatologiaRESUMO
BACKGROUND: Experience of myocardial infarction (MI) negatively affects different aspects of health-related quality of life (HRQoL). OBJECTIVES: This study aimed to examine trends in HRQoL of MI patients and to identify demographic, clinical and psychosocial predictors of HRQoL at three months. METHODS: A total of 150 patients in South Korea were completed the study questionnaires at baseline. After three months from discharge, 136 participants completed follow-up questionnaires, including the Korean version of the MacNew Quality of Life after Myocardial Infarction Questionnaire (MacNew). RESULTS: HRQoL significantly improved over three months. Younger age, ST-elevation MI, and higher LVEF, lower level of depression, better understanding of the illness and higher perceived social support at baseline were associated with better HRQoL at three months. CONCLUSION: Providing adequate information about the illness and social support as well as reducing negative psychological experiences in early days after MI may improve HRQoL of MI patients.
Assuntos
Infarto do Miocárdio/psicologia , Qualidade de Vida/psicologia , Fatores Etários , Idoso , Depressão , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Percepção , República da Coreia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Apoio Social , Volume Sistólico , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Smoking cessation is correlated with several psychological, social, biological, and pharmacological aspects. The combined tendency to experience negative emotions and to inhibit the expression of these emotions is indicated as "type D personality," an independent risk marker for clinical outcome in cardiac disease. Despite this effect of type D personality on cardiovascular disease, it is still unclear whether this personality trait may influence smoking cessation after a myocardial infarction. HYPOTHESIS: we hypothesized that there is a relationship between type D personality and smoking persistence in acute coronary syndrome patients, and this association may predict a worse long-term prognosis. METHODS: The study enrolled 231 patients with ST-segment elevation myocardial infarction, treated with primary percutaneous coronary intervention. Type D scale 14 (ds 14) was administered upon admission to the hospital. RESULTS: After controlling for demographic and clinical confounders, non-type D patients reported statistically significant higher frequencies of smoking cessation when compared with the type D group. In addition, the presence of this psychological factor anticipates significantly the onset of smoking during adolescence. Furthermore, current type D smokers had a higher incidence of cardiovascular events during long-term follow-up. CONCLUSIONS: Type D personality and smoking status increase the risk of cardiac events. An emotionally stressed personality and persistence of smoking after the first cardiac event, and mostly their mutual influence, indicate a population at high cardiovascular risk.
Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Fumar/efeitos adversos , Estresse Psicológico , Personalidade Tipo D , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Abandono do Hábito de FumarRESUMO
AIM: The aim of the study was to assess the impact of psychological and social factors on adherence to treatment in patients with primary and repeated myocardial infarction (MI). MATERIALS AND METHODS: Patients with primary (n=61) and repeated (n=72) ST-segment elevation MI were enrolled in the study. State and trait anxiety, accentuation of personality traits, patient awareness, and adherence to treatment, represented by adherence rate to treatment were evaluated. RESULTS: There were no statistically significant differences found in adherence to treatment between the study groups. Patients' adherence to treatment in the whole cohort was low positive. Patients with primary MI demonstrated higher state anxiety than patients with repeated MI (p=0.0173). The following accentuation of personality traits were determined: hypertimity, emotivity, anxiety, dysthymia and cyclothymic. They were comparable in their severity in primary and repeated MI patients. The regression analysis revealed that the higher the level of education, the higher (by 0.40 scores) adherence rate to treatment (p=0.0210). Higher patients' awareness resulted in increased adherence rate by 0.54 scores (p=0.0010). CONCLUSION: The main factors contributing to increased adherence rate in patients with MI were the level of education and awareness on the issues of preventing an unfavorable cardiovascular prognosis.
Assuntos
Cooperação do Paciente , Infarto do Miocárdio com Supradesnível do Segmento ST , Ansiedade , Estudos de Coortes , Humanos , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapiaRESUMO
BACKGROUND: Mood disorders, depression, and loneliness are established risk factors for thrombotic occlusions. Social relationships in general, and marital status in particular may play a role in predicting cardiovascular outcomes and survival after ST-segment elevation myocardial infarction (STEMI), but the evidence is inconclusive especially in Asians. METHODS: The Korean patients presented with STEMI (n=980) constituted married (n=780); or widowed, divorced, or single (WDS, n=200) groups. After the matching for age, and gender, the groups were matched 1:1, with each group containing 172 patients. Clinical characteristics and STEMI prognosis such as major adverse cardiovascular events (MACE) and death at 1year, in married versus WDS patients were collected, and retrospectively analyzed. RESULTS: Overall, the total of 70 non-fatal MACE and 51 deaths occurred. At 1-year, the WDS patients exhibited significantly more MACE (44 vs.26; p=0.016), deaths (32 vs. 19; p=0.049) and shorter time to MACE occurrence (p=0.018), compared to the married patients. There were no differences in revascularization, cerebral infarction, cerebral bleeding, major bleeding, coronary artery bypass graft, early mortality and the overall survival between groups. CONCLUSION: Marital status may be linked to 1-year MACE including survival following STEMI, while being married may improve vascular outcomes compared to WDS in Korean patients. Further larger cohort or/and uniformed national registry studies are required to validate these data, and expand the evidence beyond East Asians.
Assuntos
Estado Civil , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Projetos Piloto , República da Coreia/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Background Myocardial infarction-triggered acute stress disorder (ASD) and subclinical inflammation associate with the development of posttraumatic stress disorder, and worsen the prognosis of myocardial infarction patients. We examined the relationship between ASD severity and C-reactive protein levels in patients with acute myocardial infarction. Methods We assessed 190 patients (median age 59 years; 83% men) with a verified myocardial infarction within 48 h of an acute coronary intervention. Circulating levels of C-reactive protein were categorized according to their prognostic risk for cardiovascular disease: 0 to <5, 5 to <10, 10 to <20, and ≥ 20 mg/l. Patients completed the ASD-Scale (ASDS) for myocardial infarction-triggered symptoms and questionnaires for demographic factors, health behaviours, cardiac-related variables and psychosocial characteristics. Results The ASDS sum score was positively associated with C-reactive protein categories in the bivariate analysis ( r = 0.20, p < 0.01). Significant relationships with C-reactive protein also emerged for dissociation ( r = 0.25, p < 0.001) and avoidance ( r = 0.19, p < 0.01), but not for arousal and re-experiencing. Similarly, C-reactive protein levels ≥ 20 mg/l versus < 20 mg/l were predicted by the ASDS sum score, and the dissociation, avoidance and arousal subscores (all p-values < 0.05) in the fully adjusted binary regression analyses. C-reactive protein levels ≥ 20 mg/l were also independently predicted by male gender, body mass index, lower education, and lower left ventricular ejection fraction and higher white blood cell count. Conclusions Higher levels of myocardial infarction-triggered ASD symptoms associate with a greater inflammatory response in patients with acute myocardial infarction independently of important covariates. The findings suggest a link between myocardial infarction-triggered ASD symptoms and a heightened acute phase response with a potential impact on cardiovascular disease prognosis.
Assuntos
Proteína C-Reativa/análise , Mediadores da Inflamação/sangue , Inflamação/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Transtornos de Estresse Traumático Agudo/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/psicologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/psicologia , Prognóstico , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Transtornos de Estresse Traumático Agudo/sangue , Transtornos de Estresse Traumático Agudo/diagnóstico , Transtornos de Estresse Traumático Agudo/psicologia , Regulação para Cima , Adulto JovemRESUMO
[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
Assuntos
Transtorno Bipolar/complicações , Ponte de Artéria Coronária/ética , Doença da Artéria Coronariana/cirurgia , Consentimento Livre e Esclarecido/ética , Competência Mental , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Transtorno Bipolar/psicologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/psicologia , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologiaRESUMO
BACKGROUND: Understanding the determinants of persistent smoking after a coronary event constitutes the basis of modelling interventions of smoking cessation in secondary prevention programs. We aim to identify the potentially modifiable medical, sociodemographic and psychosocial factors, comprising the study factors, associated with unfavourable risk factor control after CHD events. METHODS: A cross-sectional explorative study used logistic regression analysis to investigate the association between study factors and smoking status in 1083 patients hospitalized with myocardial infarction and/or coronary revascularization. Hospital record data, a self-report questionnaire, clinical examination and blood samples were applied. RESULTS: At the index hospitalization, 390 patients were smoking and at follow-up after 2-36 months 167 (43%) of these had quit, while 230 reported persistent smoking. In adjusted analyses, unemployed or disability benefits (Odds ratio (OR) 4.1), low education (OR 3.5), longer smoking duration (OR 2.3) and not having ST-elevation myocardial infarction (STEMI) as index event (OR 2.3) were significantly associated with persistent smoking. Psychosocial factors at follow-up were not associated with persistent smoking. Smokers reported high motivation for cessation, with 68% wanting help to quit. Only 42% had been offered nicotine replacement therapy or other cessation aids. Smokers rated use of tobacco as the most important cause of their coronary disease (6.8 on a 1-10 Likert scale). CONCLUSIONS: Low socioeconomic status, prior duration of smoking, and not having STEMI as index event were associated with persisting smoking. Persistent smokers in this study seem to have an acceptable risk perception and were motivated to cease smoking, but needed assistance through cessation programs including prescription of pharmacological aids. TRIAL REGISTRATION: Registered at ClinicalTrials.gov: NCT02309255 , registered retrospectively.
Assuntos
Doença das Coronárias/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Prevenção Secundária/métodos , Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Fumar/efeitos adversos , Fatores Socioeconômicos , Dispositivos para o Abandono do Uso de Tabaco , Idoso , Reabilitação Cardíaca , Doença das Coronárias/diagnóstico , Doença das Coronárias/etiologia , Doença das Coronárias/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Motivação , Análise Multivariada , Revascularização Miocárdica , Noruega , Razão de Chances , Fatores de Risco , Comportamento de Redução do Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Autocuidado , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia , Fatores de TempoRESUMO
BACKGROUND: Pre-event Quality of Life (QOL) reflects the true social circumstances in which people live prior to the onset of myocardial infarctions. It is believed to be a predictor of the post-event QOL. The aim of this study was to describe the pre-event QOL and its influence on the post-event Quality of Life among patients with ST elevation (STEMI) and Non-ST elevation myocardial infarctions (NSTEMI) using Short Form-36 (SF-36), a generic QOL tool with 8 domains. Documented literature is rare in this regard in Sri Lanka, which is a lower-middle-income country. METHODS: A cross-sectional study with a 28-day post-discharge follow-up was carried out in 13 hospitals. Three hundred and forty-four patients who were diagnosed with STEMI or NSTEMI were recruited during the hospital stay. The pre-event QOL was measured using an interviewer-administered questionnaire which included the SF-36 QOL tool and medical details. Follow-up QOL was gathered using a questionnaire that was filled and posted back by participants. Of the recruited sample, 235 responded for the follow-up component. Analysis was conducted for associations between pre- and post-discharge QOL. Furthermore, comparisons were made between the STEMI and NSTEMI groups. Mann Whiney U test, Wilcoxon signed rank test and chi square test were used in the analysis. RESULTS: The post-event QOL was lower in seven out of eight domains than the pre-event QOL (p < 0.05). The NSTEMI group had more risk factors and a significantly lower pre-event QOL for seven domains (p < 0.05), when compared to the STEMI group. For seven domains, the post-discharge QOL was not significantly different (p > 0.05) between the STEMI and NSTEMI groups. Post-discharge general-health QOL domain score was higher than the pre-MI score (p = 0.028) and was higher in the STEMI group compared to the NSTEMI group (p = 0.042). Regression analysis showed a significant beta coefficient between pre- and post-QOL for five domains in STEMI and for all domains in NSTEMI groups when adjusted for the disease severity. The R square values ranged from 12.3 to 62.3% for STEMI and 7.3 to 64.8% for NSTEMI. CONCLUSIONS: Pre-event QOL is lower in the NSTEMI group compared to the STEMI group. Patients do not regain the previous QOL within one month post-discharge. Post-discharge QOL can be predicted by the pre-event QOL for most domains.