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.

[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.

Combination patterns of cardiovascular risks and sequelae at different stage of hypertension in natural hypertensive population in Beijing.

To investigate combination patterns of cardiovascular risks and sequelae at different stages of hypertension, all 6176 newly or previously diagnosed hypertensives were selected from a randomized sampling surveillance data to perform a multiple correspondence analysis. Short duration hypertensives are characterized by relatively young age, less physical exercise, normal fruits and vegetable intakes, high salt diet, and nearly normal blood lipid and glucose. Middle duration hypertensives begin to pursue more physical exercise and less salt, although increasing physiological disorders are found. Severe sequelae such as stroke and myocardial infraction mainly occurred in long duration hypertensives. Results imply that great efforts should be taken in health education and lifestyle interventions on prehypertensive and early stage hypertensive patients.

[The impact of two continuing education models on competence for hypertension diagnosis and treatment of community physicians].

OBJECTIVE: To compare the impact of two different continuing education models: traditional model and a new model entitled "problem-oriented and case-based" mutual pattern and "train the trainer" course, on improving hypertension diagnosis and treatment competence of community physicians. METHODS: A total of 632 physicians from 22 district and community hospitals in Haidian district (new model) and 20 district and community hospitals in Chaoyang district (traditional model) in Beijing were trained during July to October 2002. The survey was carried out before and 2 years after training with examination questionnaire. RESULTS: The competence evaluated as a score (maximal 100) for hypertension diagnosis and treatment of physicians was similar in physicians before training from the two districts. Post training, the score significantly increased from 40.0 to 47.4 (P < 0.01) in physicians from Chaoyang district and from 40.5 to 70.5 (P < 0.01) in physicians from Haidian district and the final score for physicians from Haidian district is significantly higher than that for physicians from increased from Chaoyang district (P < 0.01). CONCLUSION: The new model is more efficient for improving community physician's competence for diagnosing and treating hypertension.

[Serum total cholesterol and 10-year cardiovascular risk in a Chinese cohort aged 35-64 years].

OBJECTIVE: To evaluate the association between serum total cholesterol (TC) and the risk of cardiovascular diseases (CVD) in subjects aged 35-64 years. METHODS: This prospective study was performed from 1992 to 2002 in 11 provinces of China and the association between baseline TC level and the development of cardiovascular diseases was analyzed in 30 384 subjects aged 35-64 years using Cox multivariate proportional hazards regression. RESULTS: (1) Compared with the group of TC < 3.64 mmol/L (140 mg/dl), multivariate-adjusted relative risk of ischemic cardiovascular disease (ICVD, including CHD and ischemic stroke) increased continuously with increasing TC level. (2) TC level was positively related to the occurrence of ischemic stroke, but not to hemorrhagic stroke. The risk of CHD increased by 74% (RR = 1.743) and the risk of ischemic stroke increased by 12% (RR = 1.119) in the group with TC > or = 5.72 mmol/L compared with the group with TC < 5.72 mmol/L (220 mg/dl). (3) High serum cholesterol was responsible to 5.9% of ICVD, 11.7% of the acute CHD and 2.9% of the acute stroke. (4) At each TC level, the 10-year risk of ICVD increased in the presence of other risk factors. CONCLUSION: Starting from TC of 3.64 mmol/L, the risk of ICVD increases continuously with increasing TC level. Multiple risk factor intervention should be strengthened to reduce the overall risk of CVD.

[A study on the capability of dyslipidemia diagnosis and treatment among 42 community hospitals in Beijing].

OBJECTIVE: To understand the use of lipidemia related assistant examinations and lipid-lowering agents, the clinical ability among physicians in district and community hospitals in Beijing, and to evaluate the capability of dislipidemia diagnosis and treatment in these hospitals. METHODS: A survey was carried out in 42 hospitals in Chaoyang and Haidian district, including 9 district level hospitals, and the rest were at the community level. Questionnaire survey and in-depth interview were used to collect information from the leaders of related departments in those hospitals. A total number of 632 physicians in those hospitals were investigated, using a close book examination. RESULTS: 100% of the hospitals could perform TC and TG tests; 87.5% and 72.5% of the hospitals had medications as statins and bile acid, respectively; 100% of the hospitals could test ALT and 40.0% of the hospitals could test CK. The correct rates of selecting treatment strategy and determining the appropriate treatment goals were 53.7% and 17.6%, respectively. CONCLUSION: The hardware condition of community hospitals seem to have satisfied the implicit requirements of dyslipidemia evaluation and treatment but it was essential to improve the knowledge and ability among physicians in community hospitals.

[Association between serum uric acid and triglyceride in a Chinese community].

OBJECTIVE: To Study the association between the level of serum uric acid and triglyceride in a Chinese population. METHODS: In 1999, a cross-sectional study was carried out in a natural population of Beijing, using stratified-random sampling method. Serum uric acid and triglyceride were measured in 1239 subjects. RESULTS: The prevalence of hypertriglyceridemia significantly increased with increased level of serum uric acid among both the men and women. After adjusting BMI, HOMA index and alcohol consumption level with stratified methods, the incidence of hypertriglyceridemia increased with increasing level of basal serum uric acid in different levels of BMI, HOMA index and alcohol consumption. After adjusting gender, age, BMI, HOMA index, total cholesterol, smoking and alcohol consumption, the results of multivariate logistic regression analyses indicated that the odds ratio for hypertriglyceridemia as compared with the lowest quartile of serum uric acid was 1.26 (P = 0.28) for the second quartile, 1.88 (P = 0.002) for the third quartile, and 3.36 (P < 0.001) for the highest quartile. CONCLUSIONS: Serum uric acid level was strongly associated with triglyceride independent of age, genders, smoking, alcohol consumption, obesity and insulin resistance.

[The application of a systematic-dynamic model to study the computer simulation of severe acute respiratory syndrome transmission and the impact of control measures].

OBJECTIVE: (1) Building a macroscopical systematic-dynamic model of severe acute respiratory syndrome (SARS) transmission and disease control process. (2) To determine key variables on the control of SARS epidemic through computer simulation methodology, especially to analyze the effect of "screening for fever" practice during the epidemics. (3) To provide evidence for related decision-making. METHODS: Parameters in the model were collected from local hospitals and municapal CDC through interview, questionnaire survey, literature review and case analysis. A systematic-dynamic model was built under similar studies. 'What-if' analysis was used during the simulation process. RESULTS: (1) The mean duration between disease onset and hospital admission, rate of contacts of each infectious individual as well as the rate of contacts in hospital of each infectious individual appeared to be the key variables in the process of SARS transmission. (2) Physician's alertness/sense and practice of self-protection on SARS, measures on quarantine and isolation to the patients, ventilation and disinfection process in the wards appeared to be the key variables for the control of epidemics. (3) "Screening for fever" practice on each patient at the entrance of the hospital did not seem to act as an important factor to the control of the epidemics. CONCLUSION: The health system in Beijing can control SARS epidemic rapidly based on current applied disease control measures and plan.

[A prospective study of relationship between blood pressure and 10-year cardiovascular risk in a Chinese cohort aged 35-64 years].

OBJECTIVE: To provide epidemiological data for the revision of The National Guideline for Prevention and Treatment of Hypertension through the analysis of the association between blood pressure (BP) and the risk of cardiovascular diseases (CVD) in a cohort aged 35-64 years. METHODS: A prospective study was carried out in 11 provinces from 1992 to 2002. The association between BP and CVD (CHD and stroke) was analyzed in 31728 subjects aged 35 - 64 years. RESULTS: (1) Compared with BP < 110/75 mmHg, the risk of CVD increased 1 time (RR=2.09), 2 times (RR=3.23), and 10 times (RR=11.81) when BP was 120-129/80-84 mmHg, 140-149/90-94 mmHg, and > or = 180/110 mm Hg, respectively. (2) The risk of acute CHD for subjects with stage 2 hypertension was 2.3 times of those with optimal BP, whereas the risk of ischemic stroke and hemorrhagic stroke was 4.9 times and 11.7 times, respectively. (3) 36.1% of all CVDs, 44.0% of the acute stroke and 23.7% of the acute CHD were attributable to hypertension. (4) In each BP level, the 10-year risk of CVD increased with the increased number of other risk factors. CONCLUSIONS: The risk of CVD increases with BP continuously from BP of 110/75 mmHg. Therefore, the cutpoint of the diagnostic criteria for hypertension is arbitrary. Comprehensive intervention for multiple risk factor clustering should be strengthened to reduce the overall risk of CVD.

[A study on the incidence of cardiovascular disease on the metabolic syndrome in 11 provinces in China].

OBJECTIVE: To explore the association of metabolic syndrome with CVD in a cohort study involving 11 provinces. METHODS: A cohort study was carried out in a population of 27 739 subjects (age 35 - 64 years). A baseline survey on the risk factor of cardiovascular disease was done in 1992. Incidence rate and relative risk were calculated for metabolic syndromes. RESULTS: (1) The age-standardized incidence rate of cardiovascular disease for metabolic syndromes (MS) was higher than those without (MS) in this cohort (MS 652.3/100,000, not MS 206.7/100,000, RR = 3.12, P < 0.001). (2) The incidence rate of cardiovascular disease for patients with hypertension but low HDL cholesterol and high waist was the highest (910.2/100,000 in man, 930.7/100,000 in woman) among all metabolic syndromes patients. (3) The predictive risk factors for cardiovascular disease were age, cigarette smoking, BMI, total cholesterol and metabolic syndrome in men, with age, BMI and metabolic syndrome in women. CONCLUSION: The incidence rate of cardiovascular disease on the metabolic syndrome was high in 11 provinces in China. Age, BMI and metabolic syndrome were the predictive risk factors of cardiovascular disease (especially of cerebrovascular disease). It is essential to prevent risk factors of cardiovascular disease in primary and secondary prevention programs in general population.

[The trends of body mass index and overweight in population aged 25 - 64 in Beijing during 1984 - 1999].

OBJECTIVE: To analyse the trends of body mass index (BMI) and overweight in a population aged 25 through 64 years in Beijing. METHOD: During 1984 to 1999, five cross-sectional surveys on cardiovascular disease (CVD) risk factors were carried out in the CVD monitoring population in Beijing. The mean levels and trends of BMI as well overweight in different sexs, age groups and areas were analysed. RESULTS: (1) In the period of 1984 to 1999, the mean BMI increased from 23.3 to 24.0 (kg/m(2)) in population aged 25 to 64 years, and overweight increased from 27.5% to 35.9%. (2) From 1984 to 1999, the prevalence of overweight increased from 23.5% to 43.3% in males. This increasing trend was seen in both urban and rural populations and in all age groups. Prevalence of overweight decreased from 36.0% to 23.3% in urban females, but increased from 28.4% to 46.0% in rural females. (3) From 1984 to 1999, prevalence of overweight increased from 29.1% to 31.8% in urban population, while 22.1% to 49.6% in rural population. BMI and prevalence of overweight were higher in urban than in rural (P < 0.05) in 1984 to 1985 but the levels in rural were approaching and exceeding the levels in urban (P < 0.05) in 1999. CONCLUSION: Trends of BMI and overweight increased in the urban males and both males and females in the rural, while the increase of both BMI and overweight was seen more rapid in rural than in urban.

[A cross-sectional study on the usage condition of hypertension related examinations and antihypertensive drugs among 40 district and community based hospitals in Beijing].

OBJECTIVE: To study the use of hypertension related physical examinations, laboratory tests and anti-hypertension drugs among district and community based hospitals in Beijing and to analyze the possible hardware (examination, test, drug) problems under the application of the "China Hypertension Guide" in those hospitals. METHODS: The survey was carried out in 40 hospitals in Chaoyang and Haidian districts, including 9 district level hospitals, and the rest at community level. Questionnaire survey and in-depth interview were used to collect information from the leaders of related departments in those hospitals. RESULTS: (1) The hardware condition of district hospital satisfied the implicit requirements of hypertension evaluation and treatment in "China hypertension Guide". (2) 64.5% of the community level hospitals had the basic equipments and routine laboratory tests for diagnosis and treatment on hypertension, but 35.5% of them lack of tests on blood chemistry (potassium, sodium, creatinine) and urine protein. (3) 71.0% of community level hospitals could not judge the patient's "target organ damage" independently. (4) Both district and community level hospitals had all major types of anti-hypertension drugs in there pharmacy except ARB. CONCLUSION: When necessary laboratory tests for both district and community level hospitals were provided, they could accomplish the tasks of hypertension treatment and management. However, the community level hospitals should cooperate with hospitals at higher level to have a comprehensive clinical understanding of patients with high blood pressure.

[Study on the influence of knowledge about hypertension and clinical management competence among physicians treating hypertensives in district and community hospitals].

OBJECTIVE: To analyze the influence of knowledge about hypertension and clinical competence among physicians in district and community hospitals on management of hypertensives. METHODS: Questionnaire investigation was used in 9 district and community hospitals in Chaoyang and Haidian district, including 181 physicians and 204 patients with hypertension. RESULTS: (1) The hospitals involved were divided into two groups according to our evaluation on the knowledge of hypertension and clinical competence of physicians. Four hospitals were graded as high-score group and 5 hospitals as low-score group. (2) There was no significant difference on physicians' evaluation between district and community hospitals. There was higher proportion of hypertensives with instructed physical exercises, reducing salt ingestion, psychological balance and weight reduction in district hospitals than those in community ones. (3) The proportion of hypertensives who were examined with funduscopy, ambulatory pressure and instructed with physical exercises, reducing salt ingestion and weight reduction in high-score group was obviously higher than that in low-score group. The control rates of blood pressure, on the days of examination during lastest check-up or the past three months, were significantly higher in high-score group than in low-score group (P < 0.05). CONCLUSION: Knowledge of hypertension and clinical management competence among physicians in district and community hospitals did influence the management of hypertension and education of physicians and thus should be increased.

[A cross-sectional study on knowledge and the ability of hypertension treatment among physicians in district and community hospitals].

OBJECTIVE: To estimate the knowledge level and clinical ability of hypertension treatment among physicians in district and community hospitals in big and moderate cities. METHODS: 43 district and community hospitals were selected by non-random sampling in Beijing and Baotou inner-Mongolia municipality. A total of 754 physicians in those hospitals were investigated, through an examination. RESULTS: The correct rates on blood pressure stages, risk stratification and treatment strategy were 64%, 28% and 54%, respectively. The knowledge level on non-pharmacologic treatments was insufficient among physicians. The knowledge level of special indications on the common antihypertensive drugs (such as diuretics, beta-blockers, ACE inhibitors) was even worse. CONCLUSION: Physicians in district and community hospitals did not have enough knowledge and ability to fulfill the task of hypertension treatment and management.