Changes in process and outcome for ST elevation myocardial infarction in central China from 2011 to 2018 / 中华医学杂志(英文版)

BACKGROUND@#Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018.@*METHODS@#We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment.@*RESULTS@#STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment.@*CONCLUSIONS@#Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.

A survey on the cognitive function and its correlative factors in 49 centenarians / 中华老年医学杂志

Objective To evaluate the cognitive function and its correlative factors in centenarians.Methods Forty-nine subjects in Zhongxiang city were included in this mass screening.Questionnaire was utilized to collect basic data,including age,gender,ability of daily life,depression,life habits,body mass index,and history of chronic diseases on all the subjects.And the mini-mental state examination(MMSE)was adopted to evaluate cognitive function of old people.T test and chi-square test were used to compare the difference in effectiveness of multiple different factors on cognitive function,while binary logistic regression analysis was used to assess the effects of multiple different factors on cognitive function.Results The mean score of the ability of different dimensions of cognitive function was (7.10 ± 2.71) in direction,(1.94 ±± 0.80) in memory,(0.61 ± 1.07) in attention and computation,(1.92 ± 0.86) in recall,and (4.73 ± 2.14) in speech,respectively,with total score of cognitive function of(16.30±6.02) in forty-nine centenarians.Normal cognitive function was found in 25 cases,and decreased cognitive function was found in 24 cases.Single factor logistic analysis indicated that body mass index(t=-3.399,P=0.001)and self-rating depression scale(t=-5.731,P＜0.001) were lower in patients with normal cognitive function than in patients with declined cognitive function.And smoking patients were associated with higher rates of normal cognitive function than the non-smoking patients(87.5％ vs.43.9％,x2 =5.091,P=0.028),and patients with normal hearing were associated with higher rate of normal cognitive function than patients with hearing loss(70.3 ％ vs.27.3 ％,x2 =9.01,P=0.030).Multivariate logistic analysis indicated that depression index(β=-14.40,P=0.001) and body mass index(β=-0.424,P=0.015) were independent effective factors for cognitive function.Conclusions Improvement of the condition of depression and controlling the body mass index are hopeful for recovering or postponing their cognitive impairment in centenarians.