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1.
Medicine (Baltimore) ; 99(5): e18935, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000408

RESUMEN

The effect of frailty on short and long term results of interventional treatment of coronary heart disease is not well defined. The evaluation of frailty may be helpful in appointment of most suitable treatment option and timing of patient follow-up. The frailty syndrome in daily practice of interventional cardiology ward (FRAPICA) study objective is to evaluate prognostic capability of the Fried frailty scale and instrumental activities of daily living scale (IADL) in elderly patients with symptomatic coronary heart disease.This is a single center, prospective, observational study. Patients aged ≥65 years are eligible. The objectives are to report Fried frailty scale and IADL scale dispersion before hospital discharge and to assess predictive impact of both scores. The endpoints are: success of interventional treatment, its complications (procedure related myocardial infarction, dye-induced renal function deterioration, loss of blood), 3-year mortality, either all-cause and cardiovascular, re-infarction, re-intervention, stroke, new-onset heart failure, any hospital readmission, and a combination of all above mentioned. Secondary analyses will focus on distinct clinical patient presentations, sub-classifications of frailty for modeling of long-term risk.FRAPICA trial will improve understanding of the associations between frailty syndrome, cardiovascular system diseases, their invasive treatment, and short and long-term outcomes. It will allow for more individualized assessment of risk and will identify new goals for interventions. (ClinicalTrials.gov Identifier NCT03209414).


Asunto(s)
Enfermedad Coronaria/diagnóstico , Fragilidad/diagnóstico , Estudios Observacionales como Asunto , Actividades Cotidianas , Anciano , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/terapia , Anciano Frágil , Fragilidad/complicaciones , Fragilidad/mortalidad , Fragilidad/terapia , Evaluación Geriátrica , Humanos , Selección de Paciente
2.
Inquiry ; 56: 46958019886958, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31701787

RESUMEN

In large proportions of rural areas in many developing countries, health care delivery system is less developed and is less likely to be equipped to conduct sophisticated treatment for coronary heart disease (CHD) patients locally. This study aims at describing the status quo of and exploring factors associated with hospitalization costs of CHD in township hospitals where only drug therapy was available for CHD conditions. We collected data of inpatients with CHD from discharge records from 10 township hospitals in rural Liaoning from December 2013 to December 2014. We used multilevel linear regression to analyze the factors associated with CHD hospitalization costs. A total of 4635 inpatients were included in the analysis. We found that the average hospitalization costs were 6249.97 RMB (US$1012.47) with the average of 8.89 days of hospitalization in township hospitals in Liaoning. Age, gender, length of stay, the number of times of admissions, by which route was hospitalized, and type of CHD were all the factors significantly associated with hospitalization costs of CHD in township hospitals. The factors associated with hospitalization costs of CHD in township hospitals in rural China showed some different features from the existing studies. When the government designs the related policy, the policy makers need to consider the specific feature of hospitalization costs of CHD in township hospitals in rural areas.


Asunto(s)
Enfermedad Coronaria/economía , Costos de Hospital , Pacientes Internos/estadística & datos numéricos , Servicios de Salud Rural , Adulto , Anciano , Anciano de 80 o más Años , China , Enfermedad Coronaria/terapia , Femenino , Hospitalización/economía , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad
3.
Clin Interv Aging ; 14: 1607-1614, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31564843

RESUMEN

Purpose: The purpose of this study was to evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on postoperative autonomic nervous system function and serum biomarkers in the elderly. Patients and methods: A total of 122 American Society of Anesthesiologists class II or III patients with coronary heart disease undergoing spinal surgery were randomly divided into two groups: TEAS (received TEAS at Neiguan [PC6] and Ximen [PC4] for 30 minutes before anesthesia induction until the end of surgery) and control (received electrode plate at the same acupuncture points without any electrical stimulation). Serum was isolated for the measurement of concentration of high-sensitive troponin T (hs-cTnT), CRP, and CK. Heart rate (HR) and heart rate variability (HRV) including: total power (TP), low-frequency (LF) power, high-frequency (HF) power, and LF/HF ratio were used to assess autonomic nervous system function. The primary outcome was to evaluate whether TEAS changed the postoperative serum hs-cTnT. The secondary outcomes were to observe the effects of TEAS on HRV, circulating CK and CRP after surgery. Results: Hs-cTnT, CRP, and CK concentrations were significantly higher on first, third and fifth day after surgery than those before anesthesia induction in both groups. Hs-cTnT concentration was significantly lower on the first and third day after surgery in TEAS group than in control group. Compared with 1 day before surgery, TP, LF, and HF decreased significantly and HR, LF/HF increased significantly on first, third, and fifth day after surgery in control group. Compared with control group, HR was significantly lower on the first, third, and fifth day after surgery, LF/HF decreased and TP, LF, HF were significantly higher on the first day after surgery in TEAS group. Conclusion: TEAS at PC6 and PC4 could reduce postoperative serum hs-cTnT concentration and change HRV index to improve autonomic nervous system activity.


Asunto(s)
Puntos de Acupuntura , Enfermedad Coronaria/terapia , Atención Perioperativa/métodos , Estimulación Eléctrica Transcutánea del Nervio/métodos , Terapia por Acupuntura/métodos , Anciano , Sistema Nervioso Autónomo , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Estudios Prospectivos
4.
Wiad Lek ; 72(9 cz 2): 1727-1731, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31622255

RESUMEN

OBJECTIVE: Introduction: The anticipation of the development of thrombotic complications in coronary angioplasty patients helps to prevent this dangerous complication. Development of the available informative scales on the basis of mathematical methods taking into account the main clinical and biochemical parameters significantly simplifies the classification of patients in terms of thrombotic risk. The aim of the paper is to concentrate information on the state of hemostasis in the studied category of patients using the method of the main components and to obtain a matrix with minimal loss of information, which is convenient for analysis and the creation of a grade-ranking scale. PATIENTS AND METHODS: Materials and methods: Data of 70 patients with coronary heart disease and percutaneous coronary angioplasty were analyzed. The level of soluble fibrin, fibrinogen, D-dimer, protein C, and ratios rf/dd×100 were determined, and also the presence of diabetes mellitus and restenosis in the history was considered. RESULTS: Results: As a result of a stepwise study using the method of the main components, in the first stage two most singular matrices were obtained that describe 70% of the entire data variance (one of them is the component rf+dd, and the second one is fg+pc), which led to the first indicator of the level of thrombotic risk. At the second stage, the level of thrombotic risk was clarified, taking into consideration the presence of diabetes and history of restenosis, and it is recommended to use a second indicator for its determination (rf/dd×100). CONCLUSION: Conclusions: The presented grade-ranking scale scale allows the anticipation of the development of thrombotic complications in the studied category of patients with high probability.


Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Trombosis/diagnóstico , Enfermedad Coronaria/complicaciones , Diabetes Mellitus , Humanos , Recurrencia , Medición de Riesgo , Factores de Riesgo
5.
N Engl J Med ; 381(21): 2032-2042, 2019 11 21.
Artículo en Inglés | MEDLINE | ID: mdl-31556978

RESUMEN

BACKGROUND: Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy is an emerging approach to reduce the risk of bleeding after percutaneous coronary intervention (PCI). METHODS: In a double-blind trial, we examined the effect of ticagrelor alone as compared with ticagrelor plus aspirin with regard to clinically relevant bleeding among patients who were at high risk for bleeding or an ischemic event and had undergone PCI. After 3 months of treatment with ticagrelor plus aspirin, patients who had not had a major bleeding event or ischemic event continued to take ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. We also evaluated the composite end point of death from any cause, nonfatal myocardial infarction, or nonfatal stroke, using a noninferiority hypothesis with an absolute margin of 1.6 percentage points. RESULTS: We enrolled 9006 patients, and 7119 underwent randomization after 3 months. Between randomization and 1 year, the incidence of the primary end point was 4.0% among patients randomly assigned to receive ticagrelor plus placebo and 7.1% among patients assigned to receive ticagrelor plus aspirin (hazard ratio, 0.56; 95% confidence interval [CI], 0.45 to 0.68; P<0.001). The difference in risk between the groups was similar for BARC type 3 or 5 bleeding (incidence, 1.0% among patients receiving ticagrelor plus placebo and 2.0% among patients receiving ticagrelor plus aspirin; hazard ratio, 0.49; 95% CI, 0.33 to 0.74). The incidence of death from any cause, nonfatal myocardial infarction, or nonfatal stroke was 3.9% in both groups (difference, -0.06 percentage points; 95% CI, -0.97 to 0.84; hazard ratio, 0.99; 95% CI, 0.78 to 1.25; P<0.001 for noninferiority). CONCLUSIONS: Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction, or stroke. (Funded by AstraZeneca; TWILIGHT ClinicalTrials.gov number, NCT02270242.).


Asunto(s)
Aspirina/uso terapéutico , Enfermedad Coronaria/terapia , Hemorragia/inducido químicamente , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ticagrelor/uso terapéutico , Anciano , Aspirina/efectos adversos , Enfermedad Coronaria/tratamiento farmacológico , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Mortalidad , Infarto del Miocardio/epidemiología , Inhibidores de Agregación Plaquetaria/efectos adversos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Ticagrelor/efectos adversos
6.
N Engl J Med ; 381(12): 1103-1113, 2019 09 19.
Artículo en Inglés | MEDLINE | ID: mdl-31475793

RESUMEN

BACKGROUND: There are limited data from randomized trials evaluating the use of antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease. METHODS: In a multicenter, open-label trial conducted in Japan, we randomly assigned 2236 patients with atrial fibrillation who had undergone percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) more than 1 year earlier or who had angiographically confirmed coronary artery disease not requiring revascularization to receive monotherapy with rivaroxaban (a non-vitamin K antagonist oral anticoagulant) or combination therapy with rivaroxaban plus a single antiplatelet agent. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause; this end point was analyzed for noninferiority with a noninferiority margin of 1.46. The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis; this end point was analyzed for superiority. RESULTS: The trial was stopped early because of increased mortality in the combination-therapy group. Rivaroxaban monotherapy was noninferior to combination therapy for the primary efficacy end point, with event rates of 4.14% and 5.75% per patient-year, respectively (hazard ratio, 0.72; 95% confidence interval [CI], 0.55 to 0.95; P<0.001 for noninferiority). Rivaroxaban monotherapy was superior to combination therapy for the primary safety end point, with event rates of 1.62% and 2.76% per patient-year, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01 for superiority). CONCLUSIONS: As antithrombotic therapy, rivaroxaban monotherapy was noninferior to combination therapy for efficacy and superior for safety in patients with atrial fibrillation and stable coronary artery disease. (Funded by the Japan Cardiovascular Research Foundation; AFIRE UMIN Clinical Trials Registry number, UMIN000016612; and ClinicalTrials.gov number, NCT02642419.).


Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , Enfermedad Coronaria/terapia , Inhibidores del Factor Xa/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Rivaroxabán/uso terapéutico , Anciano , Aspirina/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/mortalidad , Puente de Arteria Coronaria , Enfermedad Coronaria/complicaciones , Quimioterapia Combinada/efectos adversos , Inhibidores del Factor Xa/efectos adversos , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/efectos adversos , Modelos de Riesgos Proporcionales , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Rivaroxabán/efectos adversos
7.
Curr Med Sci ; 39(3): 483-492, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31209822

RESUMEN

The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.


Asunto(s)
Enfermedad Coronaria/terapia , Ejercicio , Gastos en Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Anciano , Servicio de Cardiología en Hospital , China , Estudios de Cohortes , Enfermedad Coronaria/economía , Femenino , Encuestas de Atención de la Salud , Hospitales , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios
8.
J Clin Nurs ; 28(15-16): 2833-2843, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30938879

RESUMEN

AIMS AND OBJECTIVES: To examine the relationship between health literacy (HL) and adherence to secondary coronary heart disease (CHD) prevention behaviours in patients in China. BACKGROUND: Adherence of patients to secondary CHD prevention behaviours is important in order to slow or reverse disease progression. The relationship between HL and adherence is varied across populations and warrants further research in order to inform nurses caring for such patients how to direct their teaching. DESIGN: A descriptive cross-sectional design. METHODS: A total of 598 patients with CHD were recruited during hospitalisation for a myocardial revascularization procedure at either of two tertiary hospitals in China. Data were collected by self-report on demographics, HL and adherence to secondary CHD prevention behaviours (medication-taking and heart-healthy lifestyle) prior to this admission. HL was measured by the short version of European Health Literacy Survey Questionnaire (HLS-EU-Q16), while adherence was measured with the Medical Outcomes Study Specific Adherence Scale (MOS-SAS). Descriptive, chi-square test and regression analyses were conducted. The study was reported based on STROBE checklist. RESULTS: Overall, 74.5% of the patients had limited HL. Adherence rates to medication-taking and heart-healthy lifestyle were 84.7% and 53.2%, respectively. HL was not significantly associated with medication adherence, but in regression models patients with limited HL demonstrated significantly increased odds for nonadherence to heart-healthy lifestyle (OR 1.69). CONCLUSION: HL was not significantly associated with medication adherence but was related to heart-healthy lifestyle adherence. RELEVANCE TO CLINICAL PRACTICE: Nurses should assess the health literacy of discharging patients with CHD and focus on patients with limited health literacy to improve heart-healthy lifestyle behaviours, and not just taking medications.


Asunto(s)
Enfermedad Coronaria/terapia , Alfabetización en Salud/estadística & datos numéricos , Estilo de Vida Saludable , Cumplimiento de la Medicación/estadística & datos numéricos , Prevención Secundaria/métodos , China , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Autoinforme
9.
J Cardiovasc Med (Hagerstown) ; 20(5): 327-334, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30865139

RESUMEN

AIMS: Objective data on epidemiology, management and outcome of patients with acute cardiac illness are still scarce, and producing evidence-based guidelines remains an issue. In order to define the clinical characteristics and the potential predictors of in-hospital and long-term mortality, we performed a retrospective, observational study, in a tertiary cardiac centre in Italy. METHODS: One thousand one hundred and sixty-five consecutive patients, admitted to our intensive cardiac care unit (ICCU) during the year 2016, were included in the study. The data were collected from the hospital discharge summary and the electronic chart records. RESULTS: Global in-hospital mortality was 7.2%. Predictors of in-hospital mortality were age [odds ratio (OR): 2.0; P = 0.011], female sex (OR: 2.18; P = 0.003), cardiac arrest (OR: 12.21; P = 0.000), heart failure/cardiogenic shock (OR: 9.99; P = 0.000), sepsis/septic shock (OR: 5.54; P = 0.000), acute kidney injury (OR: 3.25; P = 0.021) and a primary diagnosis of acute heart failure or a condition other than acute heart failure and acute coronary syndrome. During a mean follow-up period of 17.4 ± 4.8 months, 96 all-cause deaths occurred in patients who were still alive at discharge. One-year mortality rate was 8.2%. Predictors of long-term mortality were age (hazard ratio: 1.08; P = 0.000), female sex (hazard ratio: 0.59; P = 0.022), comorbidity at least 3 (hazard ratio: 1,60; P = 0.047), acute kidney injury (hazard ratio: 3.15; P = 0.001), inotropic treatment (hazard ratio: 2.54; P = 0.002) and a primary diagnosis of acute heart failure. CONCLUSION: In our Level-2 ICCU, predictors of in-hospital and long-term mortality are similar to those commonly found in a Level-3 ICU. These data strongly suggest that ICUs dealing with acute cardiovascular patients should be reorganized with a necessary upgrading of competences and resources for medical and nursing staff.


Asunto(s)
Unidades de Cuidados Coronarios , Enfermedad Coronaria/mortalidad , Mortalidad Hospitalaria , Admisión del Paciente , Anciano , Anciano de 80 o más Años , Causas de Muerte , Comorbilidad , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/terapia , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Centros de Atención Terciaria , Factores de Tiempo
10.
Scand Cardiovasc J ; 53(2): 55-61, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30909763

RESUMEN

BACKGROUND: The efficacy of clopidogrel is often attenuated in the setting of renal impairment. High on-treatment platelet reactivity (HPR) is an independent correlate of adverse event. Here we performed a quantitative evaluation of the prevalence and impact of HPR in patients with chronic kidney disease (CKD). METHODS: We systematically searched PubMed, EMBASE and the Cochrane Library from their inception to 1 March 2018 for cohort studies assessing the risk ratio (RR) of prevalence of HPR in CKD versus non-CKD patients and association of cardiovascular outcome with HPR in CKD patients treated with clopidogrel. Outcome measures included major adverse cardiac event, myocardial infarction and stent thrombosis. RRs and 95% confidence intervals (CIs) were used as estimates of effect size in random-effect models. RESULTS: Ten studies comprising a total of 3028 CKD patients and 11138 non-CKD patients were included in the evaluation. Compared to patients with normal renal function, patients with CKD had a significantly higher risk of HPR (OR: 1.34, 95% CI: 1.23-1.46). In CKD patients, HPR was associated with increased risk of MACE (RR 2.99, 95% CI 1.19 to 7.53; p < 0.00001), myocardial infarction (RR1.74, 95% CI 1.29 to 2.33; p = 0.0002), and stent thrombosis (RR 2.98, 95% CI 1.42 to 6.26; p = 0.004). CONCLUSIONS: Based on pooled analysis, CKD appeared correlated with HPR and this association had prognostic significance. Further studies with standardised laboratory methods and specifically defined protocols are required to validate the clinical relevance of such response variability to clopidogrel in CKD patients.


Asunto(s)
Plaquetas/efectos de los fármacos , Clopidogrel/uso terapéutico , Enfermedad Coronaria/terapia , Riñón/fisiopatología , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/uso terapéutico , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Insuficiencia Renal Crónica/fisiopatología , Anciano , Anciano de 80 o más Años , Plaquetas/metabolismo , Clopidogrel/efectos adversos , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Resistencia a Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Inhibidores de Agregación Plaquetaria/efectos adversos , Antagonistas del Receptor Purinérgico P2Y/efectos adversos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Factores de Riesgo , Stents , Resultado del Tratamiento
12.
BMJ Open ; 9(2): e022637, 2019 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-30787075

RESUMEN

OBJECTIVE: We aimed to evaluate the effects on depression scores of a lifestyle-focused cardiac support programme delivered via mobile phone text messaging among patients with coronary heart disease (CHD). DESIGN: Substudy and secondary analysis of a parallel-group, single-blind randomised controlled trial of patients with CHD. SETTING: A tertiary hospital in Sydney, Australia. INTERVENTION: The Tobacco, Exercise and dieT MEssages programme comprised four text messages per week for 6 months that provided education, motivation and support on diet, physical activity, general cardiac education and smoking, if relevant. The programme did not have any specific mental health component. OUTCOMES: Depression scores at 6 months measured using the Patient Health Questionnaire-9 (PHQ-9). Treatment effect across subgroups was measured using log-binomial regression model for the binary outcome (depressed/not depressed, where depressed is any score of PHQ-9 ≥5) with treatment, subgroup and treatment by subgroup interaction as fixed effects. RESULTS: Depression scores at 6 months were lower in the intervention group compared with the control group, mean difference 1.9 (95% CI 1.5 to 2.4, p<0.0001). The frequency of mild or greater depressive symptoms (PHQ-9 scores≥5) at 6 months was 21/333 (6.3%) in the intervention group and 86/350 (24.6%) in the control group (relative risk (RR) 0.26, 95% CI 0.16 to 0.40, p<0.001). This proportional reduction in depressive symptoms was similar across groups defined by age, sex, education, body mass index, physical activity, current smoking, current drinking and history of depression, diabetes and hypertension. In particular, the rates of PHQ-9 ≥5 among people with a history of depression were 4/44 (9.1%) vs 29/62 (46.8%) in intervention vs control (RR 0.19, 95% CI 0.07 to 0.51, p<0.001), and were 17/289 (5.9%) vs 57/288 (19.8%) among others (RR 0.30, 95% CI 0.18 to 0.50, p<0.001). CONCLUSIONS: Among people with CHD, a cardiac support programme delivered via mobile phone text messaging was associated with fewer symptoms of mild-to-moderate depression at 6 months in the treatment group compared with controls. TRIAL REGISTRATION NUMBER: ACTRN12611000161921.


Asunto(s)
Enfermedad Coronaria/psicología , Depresión/prevención & control , Enfermedad Coronaria/prevención & control , Enfermedad Coronaria/terapia , Depresión/epidemiología , Depresión/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Método Simple Ciego , Encuestas y Cuestionarios , Mensaje de Texto
14.
Diabetes Res Clin Pract ; 150: 308-314, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30771364

RESUMEN

AIM: Most of Muslims patients with diabetes and Coronary Heart Disease (CHD) elect to fast in Ramadan, but the actual risk in this subset of patients with diabetes is largely unknown. We aimed to understand the safety of fasting in CHD patients with diabetes insisting on fasting Ramadan under optimal care. We also monitored the change in biophysical and biochemical parameters of these patients before and after Ramadan. We conducted this prospective study in a tertiary care hospital in Dubai during Ramadan 2016, (June 6th till July 5th). PATIENTS AND METHODS: 21 Patients with T2DM with stable known CHD during the three months prior to study and insisted on fasting despite advice against it were recruited for the study. All patients received continuous glucose monitoring with free style libre monitoring device (FSL-CGM) during and outside Ramadan period. We recorded DM or CVD-related emergency visit or hospitalisation, change in BMI, systolic and diastolic BP, lipids profile, e-GFR, HBA1c, and frequency of hypoglycemia during Ramadan fasting and not -fasting period. RESULTS: This is first study using CGM in CHD patients with diabetes who observe fast in Ramadan. Patients had a significantly higher incidence (3.2 ±â€¯2.8 vs 1.1 ±â€¯1.6 episodes, p = 0.033) and prolonged duration of hypoglycemia (117.8 ±â€¯87.2, 49.1 ±â€¯59.1 min p 0.022) during fasting compared to non-fasting respectively. No significant alteration was seen in BMI, SBP and DBP, lipid profile and renal function. There is a significant improvement in HBA1c during Ramadan. CONCLUSION: We could not associate any adverse cardiovascular effects with fasting Ramadan in patients with stable CHD under optimal diabetes care. FSL-CGMS data showed higher frequency of hypoglycemia during Ramadan fasting. Studies with larger sample size are needed for further validation of these findings.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/métodos , Glucemia/análisis , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/terapia , Diabetes Mellitus/terapia , Ayuno/sangre , Enfermedad Coronaria/patología , Diabetes Mellitus/patología , Femenino , Humanos , Islamismo , Masculino , Estudios Prospectivos
16.
Vascul Pharmacol ; 115: 1-12, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30685502

RESUMEN

Platelet P2Y12 receptors play a key role in platelet activation and thrombus formation. Accordingly, P2Y12 receptor antagonists are the cornerstone of secondary prevention of atherothrombotic events in patients undergoing percutaneous coronary intervention (PCI). The availability of different oral P2Y12 antagonists (clopidogrel, prasugrel, ticagrelor) along with the introduction of the first intravenous P2Y12 antagonist cangrelor offer an opportunity to individualize antiplatelet therapy according to the changing clinical setting. The recent International Expert Consensus provided the first recommendations on switching between the P2Y12 antagonists. While the consensus greatly helps to guide switching between P2Y12 antagonists, a number of controversial clinical scenarios remain where the evidence regarding the optimal switch strategy is scarce. In such clinical scenarios, understanding of the (i) pharmacological properties of P2Y12 antagonists, (ii) recent evidence from pharmacodynamics studies, clinical trials and registries, and (iii) factors affecting the efficacy and safety of the P2Y12 antagonists, all summarized below, are crucial to choose the optimal switch strategy.


Asunto(s)
Enfermedad Coronaria/terapia , Sustitución de Medicamentos , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/administración & dosificación , Antagonistas del Receptor Purinérgico P2Y/administración & dosificación , Animales , Toma de Decisiones Clínicas , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Técnicas de Apoyo para la Decisión , Árboles de Decisión , Esquema de Medicación , Humanos , Intervención Coronaria Percutánea/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/farmacocinética , Guías de Práctica Clínica como Asunto , Antagonistas del Receptor Purinérgico P2Y/efectos adversos , Antagonistas del Receptor Purinérgico P2Y/farmacocinética , Factores de Riesgo , Resultado del Tratamiento
17.
Qual Life Res ; 28(5): 1365-1376, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30607784

RESUMEN

PURPOSE: Perceived social support is known to be an important predictor of health outcomes in patients with acute coronary syndrome (ACS). This study investigates patterns of longitudinal trajectories of patient-reported perceived social support in individuals with ACS. METHODS: Data are from 3013 patients from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry who had their first cardiac catheterization between 2004 and 2011. Perceived social support was assessed using the 19-item Medical Outcomes Study Social Support Survey (MOS) 2 weeks, 1 year, and 3 years post catheterization. Group-based trajectory analysis based on longitudinal multiple imputation model was used to identify distinct subgroups of trajectories of perceived social support over a 3-year follow-up period. RESULTS: Three distinct social support trajectory subgroups were identified, namely: "High" social support group (60%), "Intermediate" social support group (30%), and "Low" social support subgroup (10%). Being female (OR = 1.67; 95% CI = [1.18-2.36]), depression (OR = 8.10; 95% CI = [4.27-15.36]) and smoking (OR = 1.70; 95% CI = [1.23-2.35]) were predictors of the differences among these trajectory subgroups. CONCLUSION: Although the majority of ACS patients showed increased or fairly stable trajectories of social support, about 10% of the cohort reported declining social support. These findings can inform targeted psycho-social interventions to improve their perceived social support and health outcomes.


Asunto(s)
Síndrome Coronario Agudo/psicología , Enfermedad Coronaria/psicología , Calidad de Vida/psicología , Autoinforme , Apoyo Social , Síndrome Coronario Agudo/terapia , Anciano , Alberta , Cateterismo Cardíaco , Estudios de Cohortes , Enfermedad Coronaria/terapia , Depresión/psicología , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción , Sistema de Registros
18.
Am J Med ; 132(5): 622-630, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30639554

RESUMEN

BACKGROUND: Identification of ST elevation myocardial infarction (STEMI) is critical because early reperfusion can save myocardium and increase survival. ST elevation (STE) in lead augmented vector right (aVR), coexistent with multilead ST depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI guidelines. We investigated the incidence of an acutely occluded coronary in patients presenting with STE-aVR with multilead ST depression. METHODS: STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. All electrocardiograms (ECGs) and coronary angiograms were blindly analyzed by experienced cardiologists. Among 847 STEMI activations, 99 patients (12%) were identified with STE-aVR with multilead ST depression. RESULTS: Emergent angiography was performed in 80% (79/99) of patients. Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography. Coronary occlusion, thought to be culprit, was identified in only 8 patients (10%), and none of those lesions were left main or left anterior descending occlusions. A total of 47 patients (59%) were found to have severe coronary disease, but most had intact distal flow. Thirty-two patients (40%) had mild to moderate or no significant disease. However, STE-aVR with multilead ST depression was associated with 31% in-hospital mortality compared with only 6.2% in a subgroup of 190 patients with STEMI without STE-aVR (p<0.00001). CONCLUSIONS: STE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.


Asunto(s)
Angiografía Coronaria , Enfermedad Coronaria , Oclusión Coronaria , Electrocardiografía , Revascularización Miocárdica , Infarto del Miocardio con Elevación del ST , Anciano , Arizona/epidemiología , Angiografía Coronaria/métodos , Angiografía Coronaria/estadística & datos numéricos , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/terapia , Oclusión Coronaria/diagnóstico , Oclusión Coronaria/epidemiología , Oclusión Coronaria/etiología , Oclusión Coronaria/terapia , Vasos Coronarios/diagnóstico por imagen , Electrocardiografía/métodos , Electrocardiografía/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/métodos , Revascularización Miocárdica/estadística & datos numéricos , Selección de Paciente , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/terapia , Índice de Severidad de la Enfermedad
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