Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a meta-analysis.

OBJECTIVE: To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) versus systemic thrombolysis (ST) in the treatment of pulmonary embolism (PE). METHODS: The Cochrane Library, PubMed, and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020, and meta-analysis was performed by STATA software (version 15.1). Using standardized data-collection forms, the authors screened the studies and independently extracted data, and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort studies. Cohort studies that examined the following results were included in the current study: in-hospital mortality, all-cause bleeding rate, gastrointestinal bleeding rate, intracranial hemorrhage rate, the incidence of shock, and hospital length of stay. RESULTS: A total of eight articles, with 13,242 participants, involving 3962 participants in the CDT group and 9280 participants in the ST group were included. CDT compared with ST in the treatment of PE can significantly affect in-hospital mortality rate [odds ratio (OR) = 0.41, 95% CI: 0.30-0.56, P < 0.05], all-cause bleeding rate (OR = 1.20, 95% CI: 1.04-1.39, P = 0.012), gastrointestinal bleeding rate (OR = 1.43, 95% CI: 1.13-1.81, P = 0.003), the incidence of shock (OR = 0.46, 95% CI: 0.37-0.57, P < 0.05), and hospital length of stay [standard mean difference (SMD) = 0.16, 95% CI: 0.07-0.25, P < 0.05]. However, there was no significant effect on intracranial hemorrhage rate in patients with PE (OR = 0.70, 95% CI: 0.47-1.03, P = 0.070). CONCLUSIONS: CDT is a viable alternative to ST in the treatment of PE, as it can significantly reduce in-hospital mortality rate, all-cause bleeding rate, gastrointestinal bleeding rate, and incidence of shock. However, CDT may prolong hospital length of stay to a certain extent. Further research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.

Prevalence of depression and anxiety symptoms and their associations with cardiovascular risk factors in coronary patients.

This study aimed to assess the prevalence of depression and anxiety in CHD patients and to explore the association between established cardiovascular risk factors and depression as well as anxiety. 2,216 patients with CHD confirmed by angiography were included in this cross-sectional study. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety symptoms. The frequencies of individual depressive and anxiety symptoms grouped by age and gender were analyzed. Binary logistic regression analyses were used to identify cardiovascular risk factors associated with anxiety and depression. The overall prevalence rates of depression and anxiety in CHD patients were 8.2% and 5.4%, respectively. There were significant differences in the frequency of depression and anxiety symptoms between genders. However, age differences among individual depression and anxiety symptoms were insignificant. In multivariable analysis, female gender, smoking, and hyperlipidemia were associated with a more frequent depression occurrence, and female gender was associated with more frequent anxiety. Depression and anxiety were not associated with other cardiovascular risk factors. These findings suggest that a substantial proportion of CHD patients experienced anxiety and depression symptoms. Differences in depressive or anxiety symptoms among the distribution of individual symptoms need more attention. Depression was significantly associated with female gender, smoking, and hyperlipidemia. No anxiety symptom associations with cardiovascular risk factors were demonstrated to be significant except for the female. More research is needed to unravel the mechanisms of depression, anxiety, and cardiovascular disease.

Trends in conventional cardiovascular risk factors and myocardial infarction subtypes among young Chinese men with a first acute myocardial infarction.

BACKGROUND: There is limited data on the characteristics of conventional risk factors (RFs) in young Chinese men hospitalized with a first acute myocardial infarction (AMI). HYPOTHESIS: We analyzed the trends in and prevalence of cardiovascular RFs and subtypes of MI during the first AMI in young Chinese men. METHODS: A total of 2739 men aged 18-44 years hospitalized for a first AMI were identified from 2007 to 2017. The overall prevalence of RFs and their respective temporal trends and subtypes of AMI were evaluated. RESULTS: The most prevalent conditions were smoking, followed by hypertension and then obesity. Patients aged <35 years had a much higher prevalence of hypercholesterolemia and obesity. Compared with a similar reference population in the United States, young Chinese men had a higher prevalence of smoking and dyslipidemia, but a lower prevalence of obesity, hypertension, and diabetes. The prevalence of hypertension increased from 2007 through 2017 (p trend <.001), whereas smoking decreased gradually. AMI frequently presented as ST-segment elevation MI (STEMI) (77.5%). Cluster of conventional RFs (3 RFs, odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.11-2.57; ≥4 RFs, OR: 2.50, 95% CI: 1.55-4.03] and multivessel disease (OR = 1.32, 95% CI: 1.08-1.60) increased the risk of non-STEMI (NSTEMI). CONCLUSIONS: Conventional RFs were highly prevalent in young Chinese men who were hospitalized for first AMI events, and the temporal trends varied different between China and US populations. Multivessel disease and cluster of conventional RFs are closely related to NSTEMI. Optimized preventive strategies among young adults are warranted.

Trends in low-density lipoprotein cholesterol level among Chinese young adults hospitalized with first acute myocardial infarction.

BACKGROUND: Representative data has shown a linear increase in mean low-density lipoprotein cholesterol (LDL-C) levels among Chinese adults, contributing to the burden of atherosclerotic cardiovascular disease (ASCVD). This study aimed to assess the trends in LDL-C levels and their association with coronary artery stenosis during the first acute myocardial infarction (AMI) in young Chinese adults. METHODS: A retrospective study including 2,781 adults, aged 18-44 years, hospitalized for their first AMI in Beijing Anzhen hospital between 2007 and 2017 was performed. RESULTS: Mean LDL-C level was 2.82±0.97 mmol/L with the prevalence of elevated LDL-C being 21.6% (601/2,781). Of the study, only 4.2% were aware of their elevated LDL-C status. Neither mean LDL-C concentration nor prevalence of elevated LDL-C showed a downward trend between 2007 and 2017 (P>0.05). Patients aged <35 years had the highest LDL-C level and frequency of elevated LDL-C among the three age groups (aged <35, 35-39, and 40-44 years; P<0.01). Patients with LDL-C ≥3.4 mmol/L evinced a more than 50% increased risk of coronary artery stenosis compared with those with LDL-C <1.4 mmol/L [adjusted odds ratio (OR) 3.19; 95% confidence interval (CI): 1.62 to 6.29]. Of the study, 62.0% had at least two conventional risk factors (RFs), and smoking, accompanied by hypertension, obesity, or elevated LDL-C were the most common combinations. CONCLUSIONS: The current study provides an overview of trends in LDL-C level and elevated LDL-C among young adults at the time of first AMI. Patients had a high prevalence of elevated LDL-C but low awareness of this status. Coronary artery stenosis was positively correlated with LDL-C level. Preventive strategies, including public education regarding cholesterol levels and benefits of maintaining LDL-C below 3.4 mmol/L should be considered for young adults as a primary preventive strategy.

Impact of Conventional Cardiovascular Risk Factors on Left Internal Mammary Artery Graft Disease.

BACKGROUND: The development of atherosclerosis was considered as the common cause of the stenosis of coronary artery grafts. Left internal mammary artery (LIMA) was the best artery graft for further effectiveness of coronary artery bypass grafting (CABG). We sought to assess the impact of known conventional cardiovascular risk factors (RFs) on LIMA graft stenosis. METHODS: A retrospective study including 618 participants, who had recurrence of chest pain after CABG, aged ≥18 years, hospitalized for coronary angiography in Beijing Anzhen hospital between 2010 and 2017 was performed. All the participants were confirmed to have LIMA graft. Multivariate analysis was conducted to determine the relationship between conventional RFs and LIMA graft stenosis. RESULTS: Of the study, 220 (35.6%) participants continued to smoke, 504 (81.6%) were overweight or obese, and 411 (66.5%) and 242 (39.2%) reported concomitant hypertension and diabetes, respectively. LIMA graft stenosis occurred in 161 participants (26.1%). Postoperative smoking, a CABG duration of ≥10 years and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis, the odds ratio (OR) was 1.86 [95% confidence interval (CI): 1.26-2.78], 2.24 (95%CI:1.33-3.478), and 2.44(95% CI:1.39-4.32), respectively. Statin use (OR, 0.28; 95% CI: 0.25-0.5) and low-density lipoprotein cholesterol (LDL-C) < 1.8 mmol/L (OR, 0.27; 95% CI: 0.14-0.53) had a significantly decreased risk of LIMA graft stenosis. While, only 15.4% (95/618) achieved the target LDL-C level. CONCLUSIONS: Postoperative smoking and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis. Statin use and LDL-C <1.8 mmol/L decreased the risk.

Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension.

BACKGROUND: Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. METHODS: Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. RESULTS: Among the 2272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2272) engaged in HBPM weekly or more frequently. Healthcare providers' advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P = 0.042; 14.3% vs. 8.1%, P = 0.002; and 19.9% vs. 12.4%, P = 0.005, respectively). Only 16.0% (165/1030) of participants actively reported their HBPM readings to doctors. CONCLUSION: The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training.

Early morning home blood pressure control among treated patients with controlled office blood pressure.

Elevated morning blood pressure (BP) has a significantly increased risk of cardiovascular events, so morning BP is of substantial clinical importance for the management of hypertension. This study aimed to evaluate early morning BP control and its determines among treated patients with controlled office BP. From May to October 2018, 600 treated patients with office BP < 140/90 mm Hg were recruited from hypertension clinics. Morning BP was measured at home for 7 days. Morning home systolic blood pressure (SBP) increased by an average of 11.5 mm Hg and that morning home diastolic blood pressure (DBP) increased by an average of 5.6 mm Hg compared with office BP. Morning home SBP, DBP, and their moving average were more likely to be lower among patients with a office SBP < 120 mm Hg than among patients with a office SBP ranging from 120 to 129 mm Hg and from 130 to 139 mm Hg (P < .001). A total of 45% of patients had early morning BP < 135/85 mm Hg. The following factors were significantly correlated with morning BP control: male sex, age of <65 years, absence of habitual snoring, no drinking, adequate physical activity, no habit of high salt intake, office BP < 120/80 mm Hg, and combination of a calcium channel blocker (CCB) and angiotensin receptor blocker or angiotensin-converting enzyme inhibitor (ARB/ACEI). Less than half of patients with controlled office BP had controlled morning BP and that positive changes may be related to an office BP < 120/80 mm Hg, combination of a CCB and ACEI/ARB and a series of lifestyle adjustments.

The impact of routine follow-up with health care teams on blood pressure control among patients with hypertension.

A series of guidelines concerning hypertension emphasize the importance of follow-up in patients' management. The aim of this study was to assess the impact of routine follow-up on blood pressure (BP) control. A total of 1511 patients with hypertension aged ≥ 35 years were selected randomly from 17 communities in two cities and four townships located in Shandong and Jiangsu provinces in China. About half of the patients visited the community clinic four or more times yearly; follow-up was conducted by telephone for 43.3%. Forty-four point two percent of patients who did not visit a community clinic received telephonic follow-up; a higher percentage of telephonic follow-up was found in patients who visited community clinics frequently. Positive changes in BP level and BP control were associated with the number of clinical visits, while no significant correlations were found with telephonic follow-up. After adjustment for covariates, a higher number of clinic visits was associated with better BP control, with odds ratios of 1.628 (95% confidence interval (CI): 1.141-2.322), 1.472 (95% CI: 1.008-2.271), and 1.790 (95% CI: 1.154-2.778) for 4-6, 7-12, and >12 visits/year, respectively. Taking an antihypertensive drug showed a strong, positive association with the number of clinic visits (OR 1.747, 95% CI: 1.484-2.056). These data suggest that health care systems may achieve greater success by increasing the frequency of clinical visits and that the positive changes may be related to improvement in medication adherence. Routine follow-up by telephone was not significantly associated with BP level and BP control.

A risk score for carotid plaque as an assessment risk of cardiovascular risk among patients with hypertension.

This study aimed to describe the status of carotid plaques and develop a simple scoring system to predict the risk of carotid lesions in patients with hypertension. Basic testing for carotid plaques was carried out and used for risk score development (the training dataset, n = 2665) and validation (the test dataset, n = 1333). Independent predictors of carotid plaques from the multivariate model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset. A total of 1346 of 2665 patients were examined for carotid plaques, which were more frequent in men than in women, and increased with age. The final model included eight significant variables, and these variables were then used to develop a risk score for the prediction of carotid plaques. Receiver operating characteristic analysis demonstrated good discriminant power with a C-statistic of 0.732 (95% confidence interval: 0.713-0.751) and good calibration across quantiles of observed predicted risk (74.6%). We developed a simple risk score for the prediction of carotid plaques based on eight variables. The prediction model showed good discriminant power and calibration.

Control of cardiovascular disease risk factors among patients with type II diabetes in a primary-care setting in Beijing.

The aim of this study was to assess the control of blood glucose, blood pressure (BP), serum low-density lipoprotein cholesterol (LDL-c), and other cardiovascular disease risk factors among patients with type II diabetes in a primary-care setting in Beijing. We performed a cross-sectional, multi-center survey of 4056 patients with type II diabetes aged ≥40 years. In total, 22.6% were current smokers, 10.8% often drank alcohol, 29.0% were obese, and 67.4% participated in adequate levels of physical activity. About 70% of patients reported comorbid hypertension or dyslipidemia. Of these, 70.8% were being treated for diabetes and 79.3% for hypertension; 20.5% were receiving statins and 28.5% aspirin. The proportions of patients achieving their therapeutic target were 52.6% for fasting plasma glucose, 58.2% for BP, and 33.0% for LDL-c. Only 11.1% achieved all three goals. Among 1960 (48.3%) patients with a record of hemoglobin A1C, 27.8% achieved the hemoglobin A1C target (<6.5%). These data suggest that blood glucose and BP were more likely to be well controlled than LDL-c, the likelihood of control of multiple risk factors is low, and that the statin and aspirin use should be intensified in patients with a substantial risk of cardiovascular disease.

Quantum secret sharing via local operations and classical communication.

We investigate the distinguishability of orthogonal multipartite entangled states in d-qudit system by restricted local operations and classical communication. According to these properties, we propose a standard (2, n)-threshold quantum secret sharing scheme (called LOCC-QSS scheme), which solves the open question in [Rahaman et al., Phys. Rev. A, 91, 022330 (2015)]. On the other hand, we find that all the existing (k, n)-threshold LOCC-QSS schemes are imperfect (or "ramp"), i.e., unauthorized groups can obtain some information about the shared secret. Furthermore, we present a (3, 4)-threshold LOCC-QSS scheme which is close to perfect.

Characterizing unextendible product bases in qutrit-ququad system.

Unextendible product bases (UPBs) play an important role in quantum information theory. However, very little is known about UPBs in Hilbert space of local dimension more than three. In this paper, we study the UPBs in qutrit-ququad system and find that there only exist six, seven and eight-state UPBs. We completely characterize the six-state and seven-state UPBs. For eight-state UPBs, seven classes of UPBs are found. As auxiliary results, we study the distinguishability of qutrit-ququad UPBs by separable measurements, and find that there exists a UPB that cannot be distinguished.

[Relations between smoking, alcohol intake, physical activity, sleeping hours and the metabolic syndrome in Chinese male aged 18 - 45 years old].

OBJECTIVE: To analyze the relationship between prevalence of metabolic syndrome (MS) and behavior habits such as smoking, alcohol intake, physical activity, sleeping hours. METHODS: A multi-stage stratified cluster sampling was conducted in 31 provinces, autonomous regions, and municipalities in China according to the program of National Nutrition and Health Survey. Questionnaire survey, interview, physical examination, measurement of biochemical indices, and dietary investigation were done. In total, 4937 men aged 18 to 45 years old were selected. RESULTS: The MS prevalence was 6.9% (329/4937). The rate of drinking was 49.4% and smoking rate was 54.4%. The percentage of sleeping was hours from 7 to 8 was 70.5%. The percentage of spending time on physical activity over 420 minutes/week was as high as 41.9%. Data from single logistic regression showed volume of smoking more than 600 packs and alcohol intake were associated with high risk of MS and no significantly associations were found between MS and the duration of physical activity and the sleeping time. Multivariate logistic regression showed that the risk of MS in smokers with the volume more than 600 packs age increased significantly as compared to nonsmokers with the odds ratio as 1.443 (95%CI: 1.044 - 1.993) and 1.765 (95%CI: 1.150 - 2.708) in smokers with volume from 600 to 899 packs age, and more than 900 packs age respectively. Compared to the nondrinkers, the odds ratios were 1.525 (95%CI: 1.135 - 2.048), 2.322 (95%CI: 1.671 - 3.255) and 2.033 (95%CI: 1.478 - 2.796) in subjects volume of alcohol drinking as 1 to 2 times per week, 3 to 4 times per week and more than 5 times per week respectively. CONCLUSION: Tobacco and alcohol were associated with high risks of MS.

[Relationship between duration of low to moderate intensity physical activity and the prevalence of metabolic syndrome].

OBJECTIVE: To analyze the relationship between low to moderate physical activity and the prevalence of metabolic syndrome (MS). METHODS: A multi-stage stratified cluster sampling was conducted in 31 provinces, autonomous regions, and municipalities in the interior of China according to the program of the National Nutrition and Health Survey in 2002. Questionnaire survey, interview, physical examination, measurement of biochemical indices and dietary investigation were done. In total, the physical activity of 26 477 persons aged 18 or above were investigated. The duration of low to moderate physical activity was divided into five grades: 0-min/week, 90-min/week, 151-min/week, 301-min/week, over 420 min/week, and the MS prevalence were investigated respectively. The relationship between MS and age (including four age groups 18-, 35-, 45-, 60 or above) or the duration of physical time were investigated. RESULTS: The MS prevalence among persons aged 18 or above was 9.4% (2490/26 477). And the prevalence was 10.3% (1191/11 516) in man and 8.7%(1299/14 961) in women, respectively (χ(2) = 21.035, P = 0.000). The MS prevalence was 2.1% (127/6070) in 18-years old group and 15.0% (1012/6734) in over 60 years old group. The MS prevalence increased with increasing age (χ(2) = 776.768, P = 0.000). 81.2% (21 499/26 477) of subjects engaged in low to moderate intensity physical activity. The percentage of spending time on physical activity over 420 min/week was dominant and as high as 43.7% (11 561/26 477). The MS prevalence was 13.8% (166/1203) for 0-min grade, 13.2% (64/485) for 90-min grade, 11.8% (153/1298) for 151-min grade, 10.1% (124/1225) for 301-min grade and 12.5% (512/4090) for over 420 min grade (χ(2) = 9.58, P = 0.047). Logistic regression analysis results showed, the MS risk of subjects spending 301-min per week on low to moderate intensity physical activity was significantly low than the MS prevalence among subjects of 90-min grade, OR = 0.844 (95%CI: 0.675 - 0.968), and no statistical difference was found in people spending over 420 min per week OR = 0.936(95%CI: 0.769 - 1.136). CONCLUSION: Most of people aged 18 or above engaged in low to moderate intensity physical activity. MS prevalence may be decreased by low to moderate intensity physical activity for 301-min per week, but the decrease was not significant while the duration of time was longer than 420 min per week.

[Analysis on long-term compliance of anticoagulation treatment and demands of disease management in patients with atrial fibrillation].

OBJECTIVE: To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation (AF). METHODS: Inpatients with AF taking warfarin were collected from Department of Internal Medicine from January 1 to December 31, 2008. Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone. RESULTS: A total of 268 AF patients received a telephone survey. Among them, 145 patients (54.1%) continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 (95%CI: 0.67-4.47), 0.87 (95%CI: 0.30-2.53), 1.59 (95%CI: 0.35-1.09), 1.09 (95%CI: 0.61-1.93) and 0.44 (95%CI: 0.12-1.60) respectively. Among patients on warfarin, INR was monitored monthly in 88 patients (60.7%) and 70 patients (48.3%) had an INR value of 2.0-3.0. Among 123 withdrawal patients, 88 patients (71.5%) terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment (35.0%) and switching to aspirin because of a poor effect (24.4%). About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients (73.1%) wished for a regular follow-up. And 176/196 patients (89.8%) opted for a telephone follow-up and 150/176 patients (85.2%) wanted to receive monthly instructions. CONCLUSION: The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to aspirin because of a poor effect. Disease management will meet most of AF patients' demands.

[Analysis on the level of exposure and the cluster of risk factors to stroke for patients with non valvular atrial fibrillation].

OBJECTIVE: To analyze the level of exposure and cluster of risk factors to stroke for patients with non valvular atrial fibrillation. METHODS: A questionnaire survey was conducted among 583 patients with non valvular atrial fibrillation, randomly selected from 8 general hospitals and 7 community health service centers located in the 8 districts in Beijing city in 2006. RESULTS: 133 patients attacked stroke and the prevalence of stroke in the total 583 patients was 22.8%. 78 patients attacked stroke after being diagnosed as atrial fibrillation with the prevalence related to atrial fibrillation as 14.3%. The levels of exposure related to age, duration of atrial fibrillation, histories of hypertension, diabetes and dyslipidemia were significantly different between stroke and non-stroke patients (P < 0.05). Data from multiple variables logistic regression analysis showed that age, duration of atrial fibrillation, history of dyslipidemia and history of diabetes increased the risk of stroke with odds ratio as 1.06, 2.08, 1.82, 1.79 respectively (95%CI was not including 1). The risk of stroke among those having 3 or 4 risk factors was 4.36 and 4.51 times of those without risk factor after adjusting for age, sex and duration of atrial fibrillation. CONCLUSION: Age, duration of atrial fibrillation, history of dyslipidemia and history of diabetes were the main risk factors related to stroke and the clustering of risk factors would further increase the risk. It is important to control blood pressure, blood surge and lipid besides therapy of anticoagulation or antiplatelet for patients with nonvalvular atrial fibrillation.

[Anticoagulation treatment in real-life practice of patient with nonvalvular atrial fibrillation in Beijing city].

OBJECTIVE: To assess the anticoagulation treatment in real-life practice for nonvalvular atrial fibrillation (AF) in Beijing. METHODS: A questionnaire survey was conducted among 583 patients with nonvalvular AFF, 327 males and 256 females, aged 40 - 93, selected randomly from 8 general hospitals (n = 375, 64.3%) and 7 community health service centers (n = 208, 35.7%) located in the 8 districts in Beijing city, mainly from the out-patient departments (n = 437, 75%). RESULTS: 110 of the 583 patients (18.9%) were prescribed warfarin in which the percentage of international normalized ratio (INR) range (2.0 - 3.0) was 39.1% (n = 43). 68.2% of them had taken warfarin for less than one year. Another 33 patients (5.7%) had ever taken warfarin. 346 patients (59.3%) took aspirin of which 85.7% were exposed to the dose of 76 - 150 mg/d, and no one was administered the dose of 325 mg/d. 18.9% of the 583 patients had not received any anticoagulation or antiplatelet drugs. 78.6% of patients had never got the advice about taking warfarin from their doctors, and over 75% of the patients lacked in knowledge about the necessity of anticoagulation treatment for AF patients. The prevalence of stroke in the total 583 patients was 22.8%, 22.0% in those receiving warfarin treatment, 24.3% in those receiving aspirin treatment, and 21.3% in those receiving neither anticoagulation treatment nor antiplatelet treatment, without significant differences among them (chi(2) = 1.09, P = 0.58). CONCLUSION: The percentage of taking anticoagulation treatment in real-life practice pf the AF patients in Beijing is lower than that of taking antiplatelet treatment. The period of anticoagulation treatment is short and the effect is not good. The percentage of taking aspirin is too high in the high risk patients of stroke, but the dose of aspirin is on the low side. Doctors' advice and knowledge related to anticoagulation treatment of the patients are important factors influencing the anticoagulation treatment.

[Analysis on hypertension control and follow up among elderly patients with hypertension in communities].

OBJECTIVE: To study hypertension control, follow up and the factors associated with the rate of hypertension control. METHODS: Through a community-based study, the routine data were collected through a community hypertension managing software for one year. RESULTS: There were 3375 hypertension patients above 60 years old recruited in the information system. In the baseline, the rate of blood pressure control was 63.5%, and arranging intervals up to 6 months was 66.9%. Hypertension control rate for the baseline, the third month and the sixth month was 61.8%, 62.4% and 61.6%, respectively (chi2 = 0.16, P = 0.69). Among hypertensives whose blood pressure was stabilized in baseline, hypertension control rates for the third month and the sixth month was 72.9.8% and 72.1%, respectively (chi2 = 0.26, P = 0.61). Blood pressure stabilized over 6 months in comparing with others, and the proportion for regular taking medication was 96.2% and 97.7% (chi2 = 3.58, P = 0.06). The proportion for physical activity, less salt intake, weight control was significantly higher in the patients whose blood pressure control well over 6 month. CONCLUSION: Rate of blood pressure control among elderly patient with hypertension who frequently consults the doctor in the community is high. Ineffectiveness in systolic and diabetes control is the important factor, which decreases the rate of blood pressure. Physical activity, less salt intake, and weight control are of help to hypertension control. For those, the blood pressure are stabilized, a follow up with 3 to 6 months interval is appropriate.

[Relationship between physical activity and metabolic syndrome].

OBJECTIVE: To investigate the relationship between physical activity and metabolic syndrome (MS). METHODS: A multi-stage stratified cluster sampling was conducted in 132 sampling 218,920 residents, aged 44.3 +/- 15.3 (15 - 96), in the 31 provinces, autonomous regions, and municipalities of the mainland China according to the program of the National Nutrition and Health Survey. Questionnaire survey, interview, physical examination, measurement of biochemical indices, and dietary investigation were done. Information of physical activity and measurement of fasting glucose and/or glucose 2 hours after meal, blood pressure, triglycerides, high-density lipoprotein cholesterol were obtained in 50,494 participants. Metabolic syndrome was defined according to the Chinese Medical Association's definition. The intensity of physical activity was divided into 3 categories according to the Center for Disease Control and Prevention of US/American College of Sports Medicine criteria. RESULTS: 50,495 subjects, 23,932 males (47.4%) and 26,562 females (52.6%), were diagnosed as with MS. The MS incidence of those with high intensity of physical activity was lower by 60% in comparison with those with low intensity of physical activity (odds ratio 0.60, 95% CI: 0.362 - 0.443) adjusted for age, sex, smoking, and alcohol intake. The risk of MS in those with moderate intensity of physical activity of 151 - 300 minutes/week was slightly decreased compared to those with moderate intensity of physical activity of 90 - 150 minutes/week, (odds ratio 0.935, 95% CI: 0.685 - 1.277), however, the risk of MS in those with the moderate intensity of physical activity over 300 minutes/week increased slightly (OR = 1.269, 95% CI: 0.923 - 1.745). The risk of MS in those with low-level physical activity of 301 - 420 minutes/week was lower by 35% in comparison with those with the low-level physical activity of 90 - 150 minutes/week (95% CI: 0.451 - 0.933), however, the risk of MS in those with the low-level physical activity over 420 minutes/week was 0.871, not significantly different from that of the subjects with the low-level physical activity of other intensity (odd ratio = 0.871, 95% CI: 0.643 - 1.181). The risk of MS of those with the vigorous physical activity odds rations for having MS of vigorous activity over 150 minutes/week was 0.757, lower by 25% in comparison with those with the vigorous physical activity of 10 - 60 minutes/week (95% CI: 0.603 - 0.951), adjusted for sex, age, smoking, alcohol intake and BMI. CONCLUSION: MS risk can be decreased by low level physical activity of 300 - 420 minutes/week, moderate physical activity of 90 - 300 minutes/week and vigorous physical activity of over 150 minutes/week.

[Analysis of outpatient hypertension treatment among different grade hospitals in Beijing].

OBJECTIVE: To analyze the therapy of hypertensive outpatients among different grade hospitals in Beijing. METHODS: Thirty-nine hospitals including 4 third grade hospitals, 4 second grade hospitals and 31 first grade hospitals in Beijing were selected randomly (by stratified randomization). The grade was accredited according to the hospital accreditation standard issued by Ministry of Health of the People's Republic of China. RESULTS: The average hypertension control rate (< 140/90 mm Hg, 1 mm Hg = 0.133 kPa) in outpatients was 32.3%. The hypertension control rate in the third grade, second grade, first grade hospitals were 37.7%, 36.9%, and 31.2% respectively. There was no difference in the control rate among the three different grade hospitals (P > 0.05). The frequency to use anti-hypertension drugs including long-acting calcium antagonism, ACEI, beta-receptor blocker in the third grade hospitals was significantly higher than those of the first and second grade hospitals. The rate of examination using ultrasonic cardiogram, CT, Holter and ambulatory blood pressure monitoring were significantly higher in the third grade hospitals than that of the first and second grade hospitals. There were significant differences in annual cost of hypertension treatment among three different grade hospitals (P < 0.01), being the highest (1567.5 yuan) in the third grade hospitals, medium (845.4 yuan) in the second grade hospitals, the lowest (651.8 yuan) in the first grade hospitals. CONCLUSIONS: Significant difference in the cost of hypertensive treatment among three different grade hospitals exists in Beijing. However, there was no difference in the control rate among them. The overall hypertension control rate is 32.3%, leaving 67.7% uncontrolled. Efforts to increase the hypertension control rate should be made in all hospitals. How to guide and arrange the hypertension patients to consult a suitable hospital is important for rational and economical use of health cost.