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2.
Clin Res Cardiol ; 105(6): 518-26, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26658679

RESUMEN

BACKGROUND: The effect of income status on patient outcome merits investigation during periods of financial crisis. We evaluated the impact of income status on out-of-hospital prognosis in a cohort of acute coronary syndrome (ACS) patients, included in a countrywide study during a period of financial crisis. METHODS: The study is a secondary analysis of a prospective, multicenter, observational study-the PHAETHON study-enrolling consecutive ACS patients in 37 hospitals in Greece. Patients were classified as low or high income based on the reported net annual household income using as a cut-off point the relative poverty threshold for Greece of 12,000 Euros. The outcome measure was survival free of the primary composite endpoint (cardiovascular death, myocardial infarction, stroke/transient ischemic attack, urgent revascularization and urgent hospitalization due to cardiovascular causes). RESULTS: The study population included 794 patients. The administration rate of evidence-based medications was similar in the low- (n = 455) and high-income (n = 339) groups during hospitalization and upon discharge. In a median follow-up of 189 days (interquartile range: 180-212 days), low-income patients had 92 % higher risk of the combined endpoint as compared to high-income patients [Hazard ratio (HR):1.92, 95 % CI:1.25-2.94, p = 0.003]. The effect of low-income status on the combined outcome remained significant after adjustment for age, gender and depression (HR:1.59, 95 % CI:1.02-2.49; p = 0.043). CONCLUSIONS: In a period of financial crisis, low income is a significant and independent predictor of poor out-of-hospital outcome in ACS patients. This association has profound implications and should be taken into consideration by public health policy makers.


Asunto(s)
Síndrome Coronario Agudo/economía , Síndrome Coronario Agudo/terapia , Recesión Económica , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Renta , Salud Pública/economía , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Anciano , Supervivencia sin Enfermedad , Femenino , Grecia/epidemiología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pobreza/economía , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
3.
Int J Cardiol ; 172(1): 115-21, 2014 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-24485633

RESUMEN

AIMS: The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population. METHODS AND RESULTS: 161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n=50, 20mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n=56, 5mg/h and 5 µg kg(-1)min(-1) respectively), or c) low-dose furosemide (LDF, n=55, furosemide 5mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P=0.74) or at one year (38.1%, 33.9% and 32.7%, P=0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P=0.55) or one year (60.0%, 50.0%, and 47%, P=0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P<0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P=0.27). No significant differences in adverse events were noted. CONCLUSIONS: In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.


Asunto(s)
Cardiotónicos/administración & dosificación , Diuréticos/administración & dosificación , Dopamina/administración & dosificación , Furosemida/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Cardiotónicos/efectos adversos , Diuréticos/efectos adversos , Dopamina/efectos adversos , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Furosemida/efectos adversos , Insuficiencia Cardíaca/mortalidad , Frecuencia Cardíaca/efectos de los fármacos , Hemodinámica , Mortalidad Hospitalaria , Humanos , Riñón/efectos de los fármacos , Masculino , Readmisión del Paciente , Método Simple Ciego , Volumen Sistólico/efectos de los fármacos , Resultado del Tratamiento , Orina
4.
Hellenic J Cardiol ; 53(1): 33-40, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22275741

RESUMEN

INTRODUCTION: Conduction of national surveys is needed to depict temporal trends in the risk profile, type of implemented treatment strategy and outcome of patients with acute coronary syndromes (ACS). The TARGET study is a multicenter, observational study that aimed to evaluate the epidemiological characteristics, management pattern and outcome of ACS patients in Greece. METHODS: A total of 418 consecutive patients with ACS (44.7% STEMI, 34.2% NSTEMI, 21.1% unstable angina) from 17 centers (52.9% with catheterization facilities) were enrolled in the study (78.0% males, 63.9 ± 12.9 years). RESULTS: Overall, 67.9% of the patients had hypertension, 27.5% were diabetics and 57.4% had dyslipidemia. Thrombolytic therapy (60.7% tenecteplase, 38.2% reteplase) was administered in 22.7% of the study population, while invasive management was performed in 40.2% of patients (27.0% PCI and 1.0% CABG) during the index hospitalization. In-hospital all-cause mortality was 1.9%, with 12.2% of patients experiencing adverse clinical events. Evidence-based medications were prescribed to the majority of enrolled patients during hospitalization and upon discharge (97% and 94% received aspirin, 93% and 84% clopidogrel, 87% and 86% beta-blockers, 96% and 93% statins, respectively). CONCLUSION: The prevalence of modifiable risk factors exhibits an increasing trend among ACS patients in Greece. The prescription pattern of evidence-based medications has improved considerably, while there remains considerable room for improvement in expanding the implementation of invasive management in realworld clinical practice.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/tratamiento farmacológico , Síndrome Coronario Agudo/fisiopatología , Anciano , LDL-Colesterol/sangre , Electrocardiografía , Femenino , Grecia/epidemiología , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Factores de Riesgo , Terapia Trombolítica
5.
J Card Fail ; 16(12): 922-30, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21111980

RESUMEN

BACKGROUND: Worsening renal function (WRF) and hypokalemia related to diuretic use for acute decompensated heart failure (ADHF) are common and associated with poor prognosis. Low-dose dopamine infusion improves renal perfusion; its effect on diuresis or renal function specifically in ADHF is not known. METHODS AND RESULTS: Sixty consecutive ADHF patients (age 75.7 ± 11.2 years; 51.7% female; left ventricular ejection fraction 35.3 ± 12.1%) were randomized, after receiving a 40 mg intravenous furosemide bolus, to either high-dose furosemide (HDF, 20 mg/h continuous infusion for 8 hours) or low-dose furosemide combined with low-dose dopamine (LDFD, furosemide 5 mg/h plus dopamine 5 µg kg(-1) min(-1) continuous infusion for 8 hours). Both strategies were compared for total diuresis, WRF (defined as a rise in serum creatinine of >0.3 mg/dL from baseline to 24 hours), electrolyte balance, and 60-day postdischarge outcomes. Mean hourly excreted urine volume (272 ± 149 mL in HDF vs 278 ± 186 mL in LDFD group; P = .965) and changes in dyspnea score (Borg index: -4.4 ± 2.1 in HDF group vs -4.7 ± 2.0 in LDFD group; P = .575) during the 8 hours of protocol treatment were similar in the two groups. WRF was more frequent in the HDF (n = 9; 30%) than in the LDFD group (n = 2; 6.7%; P = .042). Serum potassium changed from 4.3 ± 0.5 to 3.9 ± 0.4 mEq/L at 24 hours (P = .003) in the HDF group and from 4.4 ± 0.5 to 4.2 ± 0.5 mEq/L at 24 hours (P = .07) in the LDFD group. Length of stay and 60-day mortality or rehospitalization rates (all-cause, cardiovascular, and worsening HF) were similar in the two groups. CONCLUSIONS: In ADHF patients, the combination of low-dose furosemide and low-dose dopamine is equally effective as high-dose furosemide but associated with improved renal function profile and potassium homeostasis.


Asunto(s)
Dopamina/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización , Riñón/efectos de los fármacos , Riñón/fisiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Furosemida/administración & dosificación , Insuficiencia Cardíaca/fisiopatología , Hospitalización/tendencias , Humanos , Infusiones Intravenosas , Pruebas de Función Renal/tendencias , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
6.
Hellenic J Cardiol ; 48(6): 325-34, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-18196654

RESUMEN

INTRODUCTION: Taking into consideration the need for an updated survey on acute myocardial infarction (AMI) in Greece, we conducted the HELIOS study (HELlenic Infarction Observation Study), aiming to recruit a cohort of AMI patients that would be representative of the total AMI population. METHODS: The HELIOS study is a countrywide registry of AMI, conducted during 2005-2006 by the Prevention Working Group of the Hellenic Cardiological Society. We enrolled 1840 AMI pts from 31 hospitals (mean age 68 +/- 13 years, 75% men, 1096 ST-elevation myocardial infarction [STEMI] patients), with a proportional representation of all types of hospitals and of all geographical areas. The study recruited 10% of the total number of AMI cases that occur per year on a countrywide basis, taking into consideration the seasonal variations of the population in each geographical area. RESULTS: Despite demographic changes, there is still a male predominance among AMI patients and an increasing prevalence of cardiometabolic risk factors, (obesity, diabetes, hypertension) compared to previous AMI studies in the Greek population. Almost 60% of STEMI patients received reperfusion therapy, but the median value of the pain-to-door time was 180 minutes. The rates of administration of evidence-based medications during hospitalisation or upon discharge and the short-term mortality rates were in accordance with those observed in other international AMI registries. CONCLUSIONS: The HELIOS study provided valuable insights into the epidemiology, clinical characteristics, management and outcome of patients with AMI in the Greek population. Although there are notable advances compared to previous reports, there is still considerable room for improvement and we should particularly focus on minimising the time delay between arrival at the emergency department and performance of reperfusion, by either pharmacological or catheter-based approaches.


Asunto(s)
Angioplastia Coronaria con Balón/métodos , Hospitalización/estadística & datos numéricos , Infarto del Miocardio , Terapia Trombolítica/métodos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Electrocardiografía , Femenino , Estudios de Seguimiento , Grecia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Tasa de Supervivencia/tendencias , Factores de Tiempo , Resultado del Tratamiento
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