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1.
Med Pr ; 75(3): 243-254, 2024 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-38916197

RESUMO

Cardiovascular diseases (CVDs) are one of the main causes of morbidity and disability worldwide. Due to modern methods of diagnosis and treatment, it is possible to protect patients with acute coronary syndromes from myocardial infarction as well from its early complications. However, the challenge remains to improve the long-term prognosis of CVDs. Analysis of body composition using the bioelectrical impedance (BIA) appears to be a good method for assessing changes in patients' organisms following various cardiac incidents, as well as those participating in rehabilitation programmes. This study aims to provide a complementary analysis of the scientific literature and a critical review of the data from the use of BIA to assess phase angle in people with a history of cardiac diseases. This critical literature review was prepared based on the Scale for the Assessment of Narrative Review Articles recommendations. Inclusion criteria included 1) original publications of a research nature, 2) papers indexed in PubMed, Scopus, Embase databases, 3) full-text articles in English, 4) recent papers published between 2013-2023, 5) papers on the use of BIA with phase angle assessment as a prognostic factor in multiple aspects of health and disease, 6) papers showing changes in body composition in the process of cardiac rehabilitation. Based on a review of PubMed, Scopus and Embase databases, 36, 31 and 114 publications were found, respectively, chosen on the basis of precisely selected keywords and included for further full-text analysis. Exploring the role of the BIA holds lots of hope as a non-invasive method that can be used as a predictive marker for changes in the state of health in various fields of medicine. In young, healthy adults, BIA parameters may be important in identifying risk factors for the development of particular diseases, in predicting the rapid development of disease symptoms and in promoting motivation to lifestyle changes. Med Pr Work Health Saf. 2024;75(3):243-254.


Assuntos
Composição Corporal , Reabilitação Cardíaca , Doenças Cardiovasculares , Prevenção Primária , Prevenção Secundária , Humanos , Doenças Cardiovasculares/prevenção & controle , Prevenção Secundária/métodos , Impedância Elétrica , Masculino , Feminino , Pessoa de Meia-Idade
2.
J Thorac Dis ; 15(8): 4486-4496, 2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37691663

RESUMO

Background: Early cardiopulmonary exercise test (CPET) may predict the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, data from CPET to assess the exercise capacity of patients with AMI PCI are still scarce. This study aimed to evaluate the safety of the CPET and assess the predictors and clinical influence of exercise capacity measured by CPET in patients with AMI within 1 week after PCI. Methods: A total of 275 patients with AMI who underwent PCI in the acute phase were selected. Reduced exercise capacity was defined as peak oxygen uptake (VO2peak) <16 mL/kg/min. According to VO2peak, patients were divided into a normal exercise tolerance group and a reduced exercise tolerance group. The general clinical conditions were compared between the 2 groups to investigate the safety of CPET and the influencing factors of exercise tolerance. A nomogram model for predicting patients' exercise capacity was further developed. Clinical outcomes were recorded. Results: The median time of CPET in all patients was 5 days after PCI. Among the 275 patients, exercise tolerance decreased in 90 cases (32.72%). Multivariate logic analysis showed that E/e', age, glycosylated hemoglobin, and estimated glomerular filtration rate (eGFR) were independent predictors of early exercise capacity reduction in these patients. Utilizing the correlation coefficients from pre-assessment clinical and CPET indicators within the logistic regression framework, we constructed a nomogram model to forecast the diminishing exercise tolerance in AMI patients. The predictive accuracy of this model, as indicated by a C-index of 0.771 and an area under the receiver operating characteristic (ROC) curve of 0.771 (95% CI: 0.710-0.832), demonstrates its potential as a robust tool in clinical settings. During a follow-up of 24 months, the incidence of clinical outcomes in patients with low exercise tolerance was significantly higher than that in patients with normal exercise tolerance, among which all-cause mortality and reinfarction were statistically different (P=0.009 and P=0.043). Conclusions: The reduced exercise capacity in patients with AMI after initial PCI is related to age, diastolic dysfunction, renal function, and blood glucose control, which may lead to poor clinical prognosis. The nomogram prediction model performed well in predicting the declining exercise tolerance of patients with AMI.

3.
Can J Aging ; 42(4): 591-598, 2023 12.
Artigo em Francês | MEDLINE | ID: mdl-37503829

RESUMO

Cette étude visait à explorer comment les composantes clés de l'environnement des communautés favorisent les résultantes de santé d'Estriens âgés, plus précisément leur santé positive, leur participation sociale et leur équité en santé. Une étude de cas multiples a été réalisée auprès de cinq communautés estriennes (cas) à l'aide de groupes de discussion focalisée (1/communauté) regroupant un total de 49 participants connaissant bien les communautés respectives, soit 47 aînés, 1 conseillère municipale et 1 technicienne en loisir. En rendant accessible et équitable la réalisation d'activités importantes pour les aînés, la nature, une offre d'activités variée, des moyens de communication efficace et les mesures favorisant l'équité avaient une influence positive sur les résultantes de santé. Des facteurs individuels tels qu'un niveau élevé de scolarité et un statut socioéconomique favorable avaient aussi une influence positive. Ces résultats permettent d'outiller les décideurs souhaitant favoriser un vieillissement actif et en santé.

4.
Cureus ; 15(4): e37657, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37200648

RESUMO

Background Acute mesenteric ischemia (AMI) is an uncommon disease caused by obstruction of blood flow to the bowel, which can lead to high mortality rates. End-stage renal disease (ESRD) is another disease commonly seen in the elderly. There are limited data evaluating the relationship between AMI and ESRD, but it has been shown that ESRD patients have a higher risk of mesenteric ischemia than the general population. Methods This retrospective analysis utilized the National Inpatient Sample database for 2016, 2017, and 2018 to identify patients with AMI. Patients were then divided into two groups, AMI with ESRD and AMI only. All-cause in-patient mortality, hospital length of stay (LOS), and total costs were identified. The Student's t-test was used to analyze continuous variables, while Pearson's Chi-square test was used to analyze categorical variables. Results A total of 169,245 patients were identified, with 10,493 (6.2%) having ESRD. The AMI with ESRD group had a significantly higher mortality rate than the AMI-only group (8.5% vs 4.5%). Patients with ESRD had a longer LOS (7.4 days vs 5.3 days; P = 0.00), and higher total hospital cost ($91,520 vs $58,175; P = 0.00) compared to patients without ESRD. Conclusion The study found that patients with ESRD who were diagnosed with AMI had a significantly higher mortality rate, longer hospital stays, and higher hospital costs than patients without ESRD.

5.
J Gen Intern Med ; 38(6): 1449-1458, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36385407

RESUMO

BACKGROUND: The term "multimorbidity" identifies high-risk, complex patients and is conventionally defined as ≥2 comorbidities. However, this labels almost all older patients as multimorbid, making this definition less useful for physicians, hospitals, and policymakers. OBJECTIVE: Develop new medical condition-specific multimorbidity definitions for patients admitted with acute myocardial infarction (AMI), heart failure (HF), and pneumonia patients. We developed three medical condition-specific multimorbidity definitions as the presence of single, double, or triple combinations of comorbidities - called Qualifying Comorbidity Sets (QCSs) - associated with at least doubling the risk of 30-day mortality for AMI and pneumonia, or one-and-a-half times for HF patients, compared to typical patients with these conditions. DESIGN: Cohort-based matching study PARTICIPANTS: One hundred percent Medicare Fee-for-Service beneficiaries with inpatient admissions between 2016 and 2019 for AMI, HF, and pneumonia. MAIN MEASURES: Thirty-day all-location mortality KEY RESULTS: We defined multimorbidity as the presence of ≥1 QCS. The new definitions labeled fewer patients as multimorbid with a much higher risk of death compared to the conventional definition (≥2 comorbidities). The proportions of patients labeled as multimorbid using the new definition versus the conventional definition were: for AMI 47% versus 87% (p value<0.0001), HF 53% versus 98% (p value<0.0001), and pneumonia 57% versus 91% (p value<0.0001). Thirty-day mortality was higher among patients with ≥1 QCS compared to ≥2 comorbidities: for AMI 15.0% versus 9.5% (p<0.0001), HF 9.9% versus 7.0% (p <0.0001), and pneumonia 18.4% versus 13.2% (p <0.0001). CONCLUSION: The presence of ≥2 comorbidities identified almost all patients as multimorbid. In contrast, our new QCS-based definitions selected more specific combinations of comorbidities associated with substantial excess risk in older patients admitted for AMI, HF, and pneumonia. Thus, our new definitions offer a better approach to identifying multimorbid patients, allowing physicians, hospitals, and policymakers to more effectively use such information to consider focused interventions for these vulnerable patients.


Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Pneumonia , Humanos , Idoso , Estados Unidos/epidemiologia , Readmissão do Paciente , Medicare , Hospitalização , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Pneumonia/epidemiologia , Pneumonia/terapia , Pacientes Internados
6.
SSM Popul Health ; 17: 101067, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35284618

RESUMO

Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in 'recovery'; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as 'return to baseline', and we know less about patterns and predictors when recovery is situated as a 'process'. This paper seeks to address this gap. Drawing on data from the UK Household Longitudinal Study, we operationalise recovery as both an 'outcome' and as a 'process' and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a 'poor health' state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised.

7.
BMC Cardiovasc Disord ; 22(1): 81, 2022 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-35246043

RESUMO

BACKGROUND: Mortality following acute myocardial infarction (AMI) has decreased in western countries for decades; however, it remains unknown whether the decrease is distributed equally across the population independently of residential location. This study investigated whether the observed decreasing 28-day mortality following an incident AMI in Denmark from 1987 to 2016 varied geographically at municipality level after accounting for sociodemographic characteristics. METHODS: A register-based cohort study design was used to investigate 28-day mortality among individuals with an incident AMI. Global spatial autocorrelation (within sub-periods) was analysed at municipality level using Moran's I. Analysis of spatio-temporal autocorrelation before and after adjusting for sociodemographic characteristics was performed using logistic regression and conditional autoregressive models with inference in a Bayesian setting. RESULTS: In total, 368,839 individuals with incident AMI were registered between 1987 and 2016 in Denmark; 128,957 incident AMIs were fatal. The 28-day mortality decreased over time at national level with an odds ratio of 0.788 (95% credible interval (0.784, 0.792)) per 5-year period after adjusting for sociodemographic characteristics. The decrease in the 28-day mortality was geographically unequally distributed across the country and in a geographical region in northern Jutland, the 28-day mortality decreased significantly slower (4-12%) than at national level. CONCLUSIONS: During the period from 1987 to 2016, the 28-day mortality following an incident AMI decreased substantially in Denmark. However, in a local geographical region, the 28-day mortality decreased significantly slower than in the rest of the country both before and after adjusting for sociodemographic differences. Efforts should be made to keep geographical trend inequalities in the 28-day mortality to a minimum.


Assuntos
Infarto do Miocárdio , Teorema de Bayes , Estudos de Coortes , Dinamarca/epidemiologia , Humanos , Incidência
8.
Sensors (Basel) ; 21(18)2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34577436

RESUMO

Automatic meter infrastructure (AMI) systems using remote metering are being widely used to utilize water resources efficiently and minimize non-revenue water. We propose a convolutional neural network-long short-term memory network (CNN-LSTM)-based solution that can predict faulty remote water meter reading (RWMR) devices by analyzing approximately 2,850,000 AMI data collected from 2762 customers over 360 days in a small-sized city in South Korea. The AMI data used in this study is a challenging, highly unbalanced real-world dataset with limited features. First, we perform extensive preprocessing steps and extract meaningful features for handling this challenging dataset with limited features. Next, we select important features that have a higher influence on the classifier using a recursive feature elimination method. Finally, we apply the CNN-LSTM model for predicting faulty RWMR devices. We also propose an efficient training method for ML models to learn the unbalanced real-world AMI dataset. A cost-effective threshold for evaluating the performance of ML models is proposed by considering the mispredictions of ML models as well as the cost. Our experimental results show that an F-measure of 0.82 and MCC of 0.83 are obtained when the CNN-LSTM model is used for prediction.


Assuntos
Tecnologia de Sensoriamento Remoto , Água , Análise Custo-Benefício , Memória de Longo Prazo , Redes Neurais de Computação
9.
Quant Imaging Med Surg ; 11(1): 402-409, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33392039

RESUMO

BACKGROUND: The most common, potentially fatal complication following an acute myocardial infarction (AMI) is early ventricular fibrillation (EVF). According to the guidelines, the assessment of implanting an implantable cardioverter defibrillator (ICD) is sufficient 6 weeks after the event, in patients with reduced left ventricular ejection fraction (LVEF), regardless of VF. The present study aimed to evaluate the 6-week prognosis of patients surviving an EVF. We divided the patients in two group based on their general condition at the time they left the hospital. We investigated the clinical characteristics of patients discharged in good general health but still dying within 6 weeks. METHODS: The present study comprised 12,270 patients with AMI following their primary revascularization in the first 12 h of symptom onset. Five hundred and forty-seven of them suffered EVF due to the AMI. Clinical and 6-week mortality data were examined. RESULTS: Poor general condition correlates with multiple comorbidities, higher troponin levels, more severe complications after the event. Patients leaving in good condition thought to be low risk, from dying. But low LVEF, high blood sugar, high cardiac biomarker level, poor renal function elevates the risk of dying within 6 weeks. However, there is no difference in clinical characteristics between EVF- cases and EVF+ cases in good condition who dies within 6 weeks. CONCLUSIONS: According to our study we can select patients who are safe in the critical 6-week period and those who need closer follow-up despite leaving in good general condition.

10.
BMC Health Serv Res ; 20(1): 1145, 2020 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-33342431

RESUMO

BACKGROUND: Acute myocardial infarction (AMI), a major source of morbidity and mortality, is also associated with excess costs. Findings from previous studies were divergent regarding the effect on health care expenditure of adherence to guideline-recommended medication. However, gender-specific medication effectiveness, correlating the effectiveness of concomitant medication and variation in adherence over time, has not yet been considered. METHODS: We aim to measure the effect of adherence on health care expenditures stratified by gender from a third-party payer's perspective in a sample of statutory insured Disease Management Program participants over a follow-up period of 3-years. In 3627 AMI patients, the proportion of days covered (PDC) for four guideline-recommended medications was calculated. A generalized additive mixed model was used, taking into account inter-individual effects (mean PDC rate) and intra-individual effects (deviation from the mean PDC rate). RESULTS: Regarding inter-individual effects, for both sexes only anti-platelet agents had a significant negative influence indicating that higher mean PDC rates lead to higher costs. With respect to intra-individual effects, for females higher deviations from the mean PDC rate for angiotensin-converting enzyme (ACE) inhibitors, anti-platelet agents, and statins were associated with higher costs. Furthermore, for males, an increasing positive deviation from the PDC mean increases costs for ß-blockers and a negative deviation decreases costs. For anti-platelet agents, an increasing deviation from the PDC-mean slightly increases costs. CONCLUSION: Positive and negative deviation from the mean PDC rate, independent of how high the mean was, usually negatively affect health care expenditures. Therefore, continuity in intake of guideline-recommended medication is important to save costs.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Inibidores de Hidroximetilglutaril-CoA Redutases , Adesão à Medicação/estatística & dados numéricos , Infarto do Miocárdio/prevenção & controle , Inibidores da Agregação Plaquetária , Prevenção Secundária/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Continuidade da Assistência ao Paciente , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/economia , Estudos Retrospectivos
11.
Eur J Health Econ ; 21(4): 607-619, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32006188

RESUMO

OBJECTIVE: Acute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guideline-recommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years. METHODS: The study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models. RESULTS: The propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and ß-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757). CONCLUSION: Previous and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/epidemiologia , Gerenciamento Clínico , Gastos em Saúde/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Antagonistas Adrenérgicos beta/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Anticorpos Monoclonais , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/mortalidade , Combinação de Medicamentos , Feminino , Alemanha/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Revisão da Utilização de Seguros , Estimativa de Kaplan-Meier , Masculino , Inibidores da Agregação Plaquetária/administração & dosagem , Guias de Prática Clínica como Assunto , Pontuação de Propensão , Modelos de Riscos Proporcionais
12.
Environ Res ; 183: 109196, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32032814

RESUMO

This paper describes radiofrequency (RF) electromagnetic field (EMF) measurements in the vicinity of single and banks of advanced metering infrastructure (AMI) smart meters. The measurements were performed in a meter testing and distribution facility as well as in-situ at five urban locations. The measurements consisted of gauging the RF environment at the place of assessment, evaluating the worst-case electric-field levels at various positions around the assessed AMI meter configuration (spatial assessment), which ranged from a single meter to a bank of 81 m, and calculating the duty cycle of the system, i.e. the fraction of time that the AMI meters were actually transmitting (12-h temporal assessment). Both in-situ and in the meter facility, the maximum field levels at 0.3 m from the meter configurations were 10-13 V/m for a single meter and 18-38 V/m for meter banks with 20-81 m. Furthermore, 6-min average duty cycles of 0.01% (1 m) up to 13% (81-m bank) were observed. Next, two general statistical models (one for a single meter and one for a meter bank) were constructed to predict the electric-field strength as a function of distance to any configuration of the assessed AMI meters. For all scenarios, the measured exposure levels (at a minimum distance of 0.3 m) were well below the maximum permissible exposure limits issued by the International Commission on Non-Ionizing Radiation Protection (ICNIRP), the U.S. Federal Communications Commission (FCC), and the Institute of Electrical and Electronics Engineers (IEEE). Indeed, the worst-case time-average exposure level at a distance of 0.3 m from an AMI installation was 5.39% of the FCC/IEEE and 9.43% of the ICNIRP reference levels.


Assuntos
Campos Eletromagnéticos , Exposição Ambiental , Ondas de Rádio , Eletricidade , Monitoramento Ambiental , Modelos Estatísticos , Radiação Ionizante
13.
Eur Heart J ; 41(7): 870-878, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-31222249

RESUMO

AIMS: The prognosis of patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) is poorly understood. We examined major adverse cardiac events (MACE) defined as all-cause mortality, re-hospitalization for acute myocardial infarction (AMI), heart failure (HF), or stroke 12-months post-AMI in patients with MINOCA versus AMI patients with obstructive coronary artery disease (MICAD). METHODS AND RESULTS: Multicentre, observational cohort study of patients with AMI (≥65 years) from the National Cardiovascular Data Registry CathPCI Registry (July 2009-December 2013) who underwent coronary angiography with linkage to the Centers for Medicare and Medicaid (CMS) claims data. Patients were classified as MICAD or MINOCA by the presence or absence of an epicardial vessel with ≥50% stenosis. The primary endpoint was MACE at 12 months, and secondary endpoints included the components of MACE over 12 months. Among 286 780 AMI admissions (276 522 unique patients), 16 849 (5.9%) had MINOCA. The 12-month rates of MACE (18.7% vs. 27.6%), mortality (12.3% vs. 16.7%), and re-hospitalization for AMI (1.3% vs. 6.1%) and HF (5.9% vs. 9.3%) were significantly lower for MINOCA vs. MICAD patients (P < 0.001), but was similar between MINOCA and MICAD patients for re-hospitalization for stroke (1.6% vs. 1.4%, P = 0.128). Following risk-adjustment, MINOCA patients had a 43% lower risk of MACE over 12 months (hazard ratio = 0.57, 95% confidence interval 0.55-0.59), in comparison to MICAD patients. This pattern was similar for adjusted risks of the MACE components. CONCLUSION: This study confirms an unfavourable prognosis in elderly patients with MINOCA undergoing coronary angiography, with one in five patients with MINOCA suffering a major adverse event over 12 months.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/epidemiologia , Humanos , Medicare , Infarto do Miocárdio/epidemiologia , Prognóstico , Fatores de Risco , Estados Unidos/epidemiologia
14.
Heart ; 106(2): 111-118, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31554655

RESUMO

OBJECTIVE: To determine whether sex differences exist in the triage, management and outcomes associated with non-traumatic chest pain presentations in the emergency department (ED). METHODS: All adults (≥18 years) with non-traumatic chest pain presentations to three EDs in Melbourne, Australia between 2009 and 2013 were retrospectively analysed. Data sources included routinely collected hospital databases. Triage scoring of the urgency of presentation, time to medical examination, cardiac troponin testing, admission to specialised care units, and in-ED and in-hospital mortality were each modelled using the generalised estimating equations approach. RESULTS: Overall 54 138 patients (48.7% women) presented with chest pain, contributing to 76 216 presentations, of which 26 282 (34.5%) were cardiac. In multivariable analyses, compared with men, women were 18% less likely to be allocated an urgency of 'immediate review' or 'within 10 min review' (OR=0.82, 95% CI 0.79 to 0.85), 16% less likely to be examined within the first hour of arrival to the ED by an emergency physician (0.84, 0.81 to 0.87), 20% less likely to have a troponin test performed (0.80, 0.77 to 0.83), 36% less likely to be admitted to a specialised care unit (0.64, 0.61 to 0.68), and 35% (p=0.039) and 36% (p=0.002) more likely to die in the ED and in the hospital, respectively. CONCLUSIONS: In the ED, systemic sex bias, to the detriment of women, exists in the early management and treatment of non-traumatic chest pain. Future studies that identify the drivers explaining why women presenting with chest pain are disadvantaged in terms of care, relative to men, are warranted.


Assuntos
Angina Pectoris/terapia , Serviço Hospitalar de Cardiologia , Serviço Hospitalar de Emergência , Disparidades em Assistência à Saúde , Triagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Angina Pectoris/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
15.
Int J Cardiol ; 296: 8-14, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31256995

RESUMO

BACKGROUND: Despite progress in the treatment of acute myocardial infarction (AMI), long-term prognosis in MI survivors remains a challenge. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Our aim was to assess the relation between participation in MC-AMI and major adverse cardiovascular and cerebrovascular events (MACCE) in 12-month follow-up. METHODS AND RESULTS: In this single-center, retrospective analysis we compared 719 patients participating in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching, two groups of 529 subjects each were compared. MC-AMI was related with MACCE reduction by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%), higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p ≪ 0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p ≪ 0.05) and ICD implantation (2.8% vs. 0.6%, p ≪ 0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI to be inversely associated with the occurrence of MACCE (HR = 0.500, 95% Cl 0.349-0.718, p ≪ 0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint. CONCLUSIONS: MC-AMI is the first program of comprehensive care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE.


Assuntos
Reabilitação Cardíaca , Programas de Assistência Gerenciada , Infarto do Miocárdio/terapia , Idoso , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Feminino , Seguimentos , Hospitais com Alto Volume de Atendimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
16.
Eur J Prev Cardiol ; 26(17): 1828-1839, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31126196

RESUMO

AIMS: This study described the interplay between geographical and social inequalities in survival after incident acute myocardial infarction (AMI) and examined whether geographical variation in survival exists when accounting for sociodemographic characteristics of the patients and their neighbourhood. METHODS: Ringmap visualization and generalized linear models were performed to study post-AMI mortality. Three individual-level analyses were conducted: immediate case fatality, mortality between days 1 and 28 after admission and 365-day survival among patients who survived 28 days after admission. RESULTS: In total, 99,013 incident AMI cases were registered between 2005 and 2014 in Denmark. Survival after AMI tended to correlate with sociodemographic indicators at the municipality level. In individual-level models, geographical inequality in immediate case fatality was observed with high mortality in northern parts of Jutland after accounting for sociodemographic characteristics. In contrast, no geographical variation in survival was observed among patients who survived 28 days. In all three analyses, odds and rates of mortality were higher among patients with low educational level (odds ratio (OR) (95% credible intervals) of 1.20 (1.12-1.29), OR of 1.12 (1.01-1.24) and mortality rate ratio of 1.45 (1.30-1.61)) and low income (OR of 1.24 (1.15-1.33), OR of 1.33 (1.20-1.48) and mortality rate ratio of 1.25 (1.13-1.38)). CONCLUSION: Marked geographical inequality was observed in immediate case fatality. However, no geographically unequal distribution of survival was found among patients who survived 28 days after AMI. Results additionally showed social inequality in survival following AMI.


Assuntos
Infarto do Miocárdio/mortalidade , Fatores Socioeconômicos , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Escolaridade , Humanos , Renda , Pessoa de Meia-Idade , Sistema de Registros , Características de Residência
17.
Health Policy ; 123(5): 441-448, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30905525

RESUMO

OBJECTIVE: To examine the variability of hospital performance within and across countries, using 30-day acute myocardial infarction (AMI) mortality, and to study the impact of hospital characteristics on performance. STUDY SETTING: Hospital-level adjusted risk standardized mortality rates (RSMR) and hospital characteristics were collected from 10 OECD and two collaborating countries including 1,163 hospitals. STUDY DESIGN: Associations between RSMR and hospital characteristics were studied using univariate and multivariate linear regressions. Clusters of hospitals were created using hierarchical clustering and mortality compared using linear regression. FINDINGS: Wide variation between countries was found for RSMR and hospital characteristics. Regression models showed large country effects. A high volume of AMI admission was associated with lower RSMR in a model using a restricted number of hospital characteristics (-0.83, p < 0.001) but not in a model using all characteristics (-1.03, p = 0.06). Analysis within countries supported this association. Hospital clusters showed clear differences in characteristic distributions but no difference in RSMR. CONCLUSIONS: The effect of volume may support policies toward a concentration of services within the hospital sector. The effect of other hospital characteristics was inconclusive and suggests the importance of system-wide characteristics or pathways of care (i.e. timeliness and nature of initial response and during transportation to a hospital, transfers between hospitals, post-discharge organization) in explaining variation.


Assuntos
Tamanho das Instituições de Saúde , Hospitais/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais/classificação , Humanos , Organização para a Cooperação e Desenvolvimento Econômico , Indicadores de Qualidade em Assistência à Saúde
18.
Health Econ ; 27(10): 1435-1449, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29863291

RESUMO

This paper evaluates the causal effect of environmental tobacco exposure on health by exploiting the time and geographical variation in public-place smoking bans implemented in Switzerland between 2007 and 2011. We use administrative data on hospitalizations for acute myocardial infarction, which allow to measure the short-run effects of the policy on an objective metric of health. We show that the incidence of acute myocardial infarction decreases by approximately 8% immediately after implementation of the law with large heterogeneity across regions. Our results indicate that the policy was effective in reducing the negative externality of smoking with potential spillovers on health inequality.


Assuntos
Infarto do Miocárdio/epidemiologia , Política Antifumo/legislação & jurisprudência , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Fatores Etários , Idoso , Feminino , Política de Saúde/legislação & jurisprudência , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Prevenção do Hábito de Fumar , Suíça/epidemiologia , Poluição por Fumaça de Tabaco/legislação & jurisprudência
19.
J Magn Reson Imaging ; 48(6): 1602-1609, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29734489

RESUMO

BACKGROUND: Acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide and places a significant financial burden on our society. PURPOSE: To determine the feasibility of cardiac intravoxel incoherent motion (IVIM) in the consecutive evaluation of myocardial perfusion in myocardial infarction patients postpercutaneous coronary intervention (PCI) and to investigate the dynamic biological phenomena in myocardial perfusion after AMI. STUDY TYPE: Prospective observational study. POPULATION: Twenty ST-segment elevation myocardial infarction (STEMI) patients after reperfusion therapy and 12 healthy volunteers served as controls. FIELD STRENGTH/SEQUENCE: Cardiac MRI at 3T, including steady-state free precession (SSFP) cine imaging, T2 -short time inversion recovery (T2 -STIR), late gadolinium enhancement (LGE), T2 mapping, and IVIM diffusion-weighted imaging (DWI) were performed. ASSESSMENT: Myocardial T2 value and IVIM-DWI-associated parameters (ADCfast , ADCslow , and f value) of the infarcted myocardium at different timepoints, remote myocardium, and normal myocardium were analyzed by two experienced radiologists. STATISTICAL TESTS: Independent sample's t-test, Pearson's, and Spearman's correlation and interobserver variability were applied. P ≤ 0.05 was considered significant. RESULTS: The T2 value in ischemic myocardium measured on day 3 (73.58 ± 4.37 msec) was greater than at any other timepoint (24 hours, day 7, day 30; 66.66 ± 4.71 msec, 68.36 ± 4.18 msec, 64.98 ± 5.39 msec, respectively, P < 0.001). ADCfast and f values were significantly lower in ischemic myocardium than in the remote myocardium as well. The f value in ischemic myocardium at day 3 (0.0989 ± 0.02) was lower than at any other timepoint (24 hours, 7 day, 30 day; 0.1203 ± 0.02, 0.1109 ± 0.02, 0.1213 ± 0.02, respectively, P < 0.001. DATA CONCLUSION: This preliminary study demonstrated that a dynamic process exists in the status of myocardial edema and myocardial perfusion in MI patients after PCI. The findings suggest myocardial perfusion would be best evaluated between day 3 and day 7. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1602-1609.


Assuntos
Imagem de Difusão por Ressonância Magnética , Coração/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Adulto , Idoso , Meios de Contraste , Edema , Feminino , Gadolínio , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Isquemia Miocárdica/diagnóstico por imagem , Miocárdio/patologia , Intervenção Coronária Percutânea , Estudos Prospectivos
20.
Prehosp Disaster Med ; 33(1): 89-97, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29293077

RESUMO

Introduction In a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care. OBJECTIVE: This systematic literature review and environmental scan addresses NAM's recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight? METHODS: To answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved. RESULTS: A total of 58 peer-reviewed articles met inclusion criteria; 46 included process, 36 outcomes, and 18 structural measures. Most studies applied quality measures at the personnel level (40), followed by the agency (28) and system of care (28), and few at the oversight level (5). Numerous grey literature articles provided principles for high-quality EMS oversight. CONCLUSIONS: Limited quality measurement at the oversight level is an important gap in the peer-reviewed literature. The grey literature is ahead in this realm and can guide the policy and research agenda for EMS oversight quality measurement. Taymour RK , Abir M , Chamberlin M , Dunne RB , Lowell M , Wahl K , Scott J . Policy, practice, and research agenda for Emergency Medical Services oversight: a systematic review and environmental scan. Prehosp Disaster Med. 2018;33(1):89-97.


Assuntos
Serviços Médicos de Emergência/organização & administração , Formulação de Políticas , Qualidade da Assistência à Saúde , Pesquisa/organização & administração , Política de Saúde , Humanos , Avaliação das Necessidades , Estados Unidos
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