[Application and Effect of Patient Portal System in the Remote Management of Chronic Diseases for Older Adults With Coronary Heart Disease]. / æ‚£è€ é—¨æˆ·ç³»ç»Ÿåœ¨è€å¹´å† å¿ƒç— æ ¢ç— è¿œç¨‹ç®¡ç†ä¸­çš„åº”ç”¨åŠæ•ˆæžœ.

Objective: To investigate the application of personal health record (PHR) and chronic disease management platform established on the basis of patient portal system (PPS) in managing older adults with coronary heart disease and to examine the effect on patients' self-care ability, coping mode, and quality of life. Methods: A total of 532 elderly patients with coronary heart disease were included in the study. All the participants enrolled were admitted to a tertiary-care hospital between January 2019 and June 2021. They were randomly assigned to the study group (269 cases) and the control group (263 cases). Patients in the control group were discharged with the routine discharge procedures and received the routine follow-up care. On the other hand, patients in the study group were discharged and followed up through the PHR and chronic disease management platform established on the basis of PPS. After 6 months, 12 months, and 18 months of patient management, the Exercise of Self-Care Agency (ESCA) Scale, Medical Coping Modes Questionnaire (MCMQ) and Seattle Angina Questionnaire (SAQ) were used to evaluate the patients' self-care ability, coping mode, and quality of life, respectively. The patient management effects of the two groups were analyzed. Results: Before the management programs started, there was no statistically significant difference in the scores for the scales between the two groups of patients. After 6 months, 12 months, and 18 months of patient management, the ESCA scores of both groups were higher than those before patient management started (P<0.05). Facing scores in the MCMQ of both groups were higher than those before patient management started (P<0.05), while the scores for avoidance and yielding were lower than those before patient management started (P<0.05). The SAQ scores of both groups were higher than those before patient management started (P<0.05). After 6 months, 12 months and 18 months of patient management, the ESCA scores of the study group were always higher compared with those of the control group (P<0.05). The facing score of the study group was higher, while the scores for avoidance and yielding were lower compared with those of the control group (P<0.05). The SAQ scores of the study group were higher compared with those of the control group (P<0.05). The medication compliance rate in the study group (83.27%) was higher than that in the control group (69.96%) (P<0.05). The incidence of adverse cardiovascular events in the study group (4.09%) was lower than that in the control group (10.27%) (P<0.05). The average times of emergency treatment and readmission in the study group were lower compared with those of the control group (P<0.05). The patient satisfaction score of the study group was higher compared with that of the control group (P<0.05). Conclusion: The PHR and chronic disease management platform established on the basis of PPS can increase the convenient access to medical care among elderly patients with coronary heart disease, which is conducive to improving their self-care ability, coping mode, and quality of life. In addition, the patient management effect is good.

Racial and Ethnic Disparities in the Management of Chronic Coronary Disease.

Chronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedures. Recognizing and addressing the historical factors underlying these disparities is crucial for enhancing the quality and equity of CCD management within an increasingly diverse population.

Chronic Coronary Disease in Older Adults.

The number of older adults age ≥75 with chronic coronary disease (CCD) continues to rise. CCD is a major contributor to morbidity, mortality, and disability in older adults. Older adults are underrepresented in randomized controlled trials of CCD, which limits generalizability to older adults living with multiple chronic conditions and geriatric syndromes. This review discusses the presentation of CCD in older adults, reviews the guideline-directed medical and invasive therapies, and recommends a patient-centric approach to making treatment decisions.

Post-discharge nutritional management for patients with coronary heart disease and frailty: a qualitative study.

BACKGROUND: Frail elderly patients experience physiological function and reserve depletion, leading to imbalances in their internal environment, which increases the risk of coronary heart disease recurrence and malnutrition. However, the majority of these patients, who primarily have a low level of education and lack self-management skills, face difficulties actively dealing with obstacles during the transition period after their discharge from hospitalization. Therefore, it is necessary to understand and discuss in depth the nutrition management experience of discharged elderly patients with coronary heart disease and frailty (ages 65-80 years old) and to analyze the promoting and hindering factors that affect scientific diet behavior during the discharge transition period. METHODS: Fifteen elderly patients with coronary heart disease and frailty who had been discharged from the hospital for 6 months were interviewed using a semistructured method. The directed content analysis approach to descriptive research was used to extract topics from the interview content. RESULTS: All participants discussed the problems in health nutrition management experience of discharged. Five topics and ten subtopics were extracted, such as ①Weak perceptions and behaviors towards healthy eating (personal habit solidification, negative attitudes towards nutrition management), ②Lack of objective factors for independently adjusting dietary conditions (reliance on subjective feelings, times of appetite change), ③Personal hindrance factors (memory impairment, deficiencies in self-nutrition management), ④Expected external support (assistance care support, ways to obtain nutritional information), ⑤Lack of continuous nutrition management (interruption of professional guidance, avoidance of medical treatment behavior). CONCLUSIONS: Nutrition management after discharge places a burden on elderly patients with coronary heart disease and frailty. According to the patients' physical conditions, we should develop a diet support system that is coordinated by individuals, families and society.

[General practitioners' perspectives on the perceived effectiveness of the disease management programs for type 2 diabetes and coronary heart disease: Results of a focus group study]. / Die wahrgenommene Effektivität der Disease Management Programme für Diabetes mellitus Typ 2 und Koronare Herzkrankheit aus Sicht von Hausärzt*innen ­ Ergebnisse einer Fokusgruppenstudie.

BACKGROUND: The majority of patients in disease management programs (DMPs) for type 2 diabetes (T2DM) and coronary heart disease (CHD) in Germany are enrolled by their general practitioner (GP). The aim of this study was, in the context of upcoming DMP expansions, to elicit GPs' current experiences and opinions regarding the perceived effectiveness and acceptance of the DMPs T2DM and CHD, as well as to determine beneficial and hindering aspects of the implementation of these programs from a GP's perspective. METHODS: In August and September 2020, 20 GPs of teaching practices of the University Hospital Cologne with experiences in DMPs were interviewed in semi-structured focus group discussions. Their expectations, attitudes and opinions regarding the DMPs T2DM and CHD were evaluated and analyzed according to the content-structuring qualitative content analysis by Kuckartz. RESULTS: The DMP T2DM was rated as generally positive by the respondents due to the structured treatment including regular foot and eye examinations, close patient contacts and perceptions of improved health outcomes. The DMP CHD was rated more negatively by the respondents because of a high and partly unnecessary documentation workload and limited therapeutic freedom, leading to a perceived ineffectiveness for patients' health outcomes. Thus, there was a discrepancy in the perceived effectiveness of the examined DMPs, causing a lower acceptance of the DMP CHD. Therefore, some of the respondents tended to enroll fewer patients into the DMP CHD or to drop out of the DMP CHD. DISCUSSION: In order to increase the acceptance and sustainability of DMPs some elements of the DMP CHD as well as the remuneration and the documentation need to be reconsidered. Additionally, future studies on the acceptance of DMPs should differentiate between different DMPs in order to generate valid results.

Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease.

BACKGROUND: Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients. OBJECTIVE: To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease. DESIGN: In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018-2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease. PARTICIPANTS: A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included. MAIN MEASURES: All-cause and ambulatory care sensitive condition hospitalizations in 2018. KEY RESULTS: There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88-0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20-1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92-0.99) for all beneficiaries. CONCLUSIONS: Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.

Cell Therapy in the Treatment of Coronary Heart Disease.

Heart failure is a leading cause of death in patients who have suffered a myocardial infarction. Despite the timely use of modern reperfusion therapies such as thrombolysis, surgical revascularization and balloon angioplasty, they are sometimes unable to prevent the development of significant areas of myocardial damage and subsequent heart failure. Research efforts have focused on developing strategies to improve the functional status of myocardial injury areas. Consequently, the restoration of cardiac function using cell therapy is an exciting prospect. This review describes the characteristics of various cell types relevant to cellular cardiomyoplasty and presents findings from experimental and clinical studies investigating cell therapy for coronary heart disease. Cell delivery methods, optimal dosage and potential treatment mechanisms are discussed.

Efficacy and safety of different traditional Chinese health exercises in patients with coronary heart disease combined with chronic heart failure: A network meta-analysis.

BACKGROUND: Non-pharmacological treatments, particularly TCM health exercises, have garnered attention for their affordability, ease of access, and potential health advantages. Despite this interest, systematic and direct comparative studies assessing the effectiveness and safety of these therapies in patients with CHD-CHF remain scarce. METHODS: This study aimed to compare the efficacy and safety of conventional treatment, conventional treatment integrated with aerobic endurance training, and various TCM health exercises in treating patients with CHD-CHF using NMA. The analysis was designed to provide a reference for developing treatment plans. To achieve this, literature databases were searched for RCTs on different TCM health exercises for CHD-CHF patients up to December 6, 2022. Major outcomes analyzed included NT-proBNP, LVEF, 6-minute walk test, MLHFQ, clinical effectiveness, and adverse event occurrence. The Cochrane risk of bias tool was employed to assess the risk of bias in the included RCT studies. Systematic review with NMA was conducted using RevMan 5.4 and Stata for cumulative ranking, and comparative adjustment funnel plot analysis. RESULTS: Traditional Chinese medicine gong methods included BaDuanJin (A) and TaiChiQuan (B). The NMA and SUCRA results revealed that: A + D and A + C + D were most likely to be the best interventions to improve NT-proBNP; B + D and A + C + D were most likely to be the best interventions to improve LVEF; A + D and A + C + D were the best interventions to improve 6WMT in CHD-CHF patients; B + C + D had the best effect on shrinking LVESD;A + D and B + C + D was likely the best interventions for contracting LVEDD;B + D and A + D were consistent in their capacity to improve MLHFQ in patients with CHD-CHF, but B + D had better efficacy. Unlike A + C + D, B + C + D was the best intervention to improve MLHFQ. In contrast with interventions, including Dand C + D, B + D was the most clinically effective intervention. Unlike interventions including B + C + D, C + D, and D, A + C + D was the most clinically efficient intervention. CONCLUSION: The findings of this NMA showed that traditional Chinese health exercises integrated with conventional treatment are more effective than conventional treatment (D) alone in patients with CHD-CHF, with A + D, B + D, B + C + D, and A + C + D considered potentially optimal treatment interventions.

A Scoping Review of Predictors Associated with Self-Efficacy Among Patients with Coronary Heart Disease.

Self-efficacy (SE) is the main predictor of self-care behaviour in patients with coronary heart disease (CHD). Several studies identified factors that influence SE in CHD patients. However, review studies have yet to synthesize these results systematically. This review aims to identify SE and the factors influencing SE in CHD patients. This scoping review is reported based on the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched using relevant keywords using five databases: CINAHL Plus with Full Text and Academic Search Complete, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar, which was accessed on June 23, 2023. Articles with an observational design were included without date restrictions. The quality of evidence was assessed using the Joanna Briggs Institute critical appraisal checklist, and data synthesis used thematic analysis. We found 11 articles discussing SE and the factors influencing SE in CHD patients. In this review, most studies reported that the SE level of CHD patients tends to be low to moderate. Factors associated with SE in this population are classified into three categories (low, moderate, and high). Cardiac knowledge and patient activation are the most influential predictors of SE in CHD patients. Public health interventions such as raising awareness about heart disease, modifying health behaviours, early screening, diagnosis, and appropriate treatment are critical to improving SE and cardiac care outcomes.

The recent advances in cell delivery approaches, biochemical and engineering procedures of cell therapy applied to coronary heart disease.

Cell therapy is an important topic in the field of regeneration medicine that is gaining attention within the scientific community. However, its potential for treatment in coronary heart disease (CHD) has yet to be established. Several various strategies, types of cells, routes of distribution, and supporting procedures have been tried and refined to trigger heart rejuvenation in CHD. However, only a few of them result in a real considerable promise for clinical usage. In this review, we give an update on techniques and clinical studies of cell treatment as used to cure CHD that are now ongoing or have been completed in the previous five years. We also highlight the emerging efficacy of stem cell treatment for CHD. We specifically examine and comment on current breakthroughs in cell treatment applied to CHD, including the most effective types of cells, transport modalities, engineering, and biochemical approaches used in this context. We believe the current review will be helpful for the researcher to distill this information and design future studies to overcome the challenges faced by this revolutionary approach for CHD.

Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China.

BACKGROUND: Medical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments. OBJECTIVES: To explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach. METHODS: The diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy. RESULTS: There were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients. CONCLUSIONS: The capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients.

Application Effects of NNN-link Care Model in Patients with Coronary Heart Disease.

OBJECTIVE: To investigate the effect of a NNN-linked care model applied in elderly patients with coronary heart disease. METHODS: A total of 120 elderly patients with coronary heart disease admitted to the hospital from January, 2023 to May, 2023 were randomly divided into two groups of 60 cases respectively. The control group received routine intervention, and the observation group received the NNN-linked care model. Changes in cardiac function, the ability for self-care, and quality of life were recorded between the groups before and after the intervention. RESULTS: Indices of cardiac function in the observation group were higher than those of the control group after 3 weeks (p < 0.05). Compared with the control group, the total score for the ability for self-care and the scores of each dimension of the observation group were higher after 3 weeks of intervention (p < 0.05). The scores of quality of life of the observation group were higher in comparison with the control group after 3 weeks of intervention (p < 0.05). CONCLUSION: The application of the NNN-linked care model to elderly patients with coronary heart disease can improve the ability for self-care, increase cardiac function and improve the quality of life.

Nanotechnology in coronary heart disease.

Coronary heart disease (CHD) is one of the major causes of death and disability worldwide, especially in low- and middle-income countries and among older populations. Conventional diagnostic and therapeutic approaches have limitations such as low sensitivity, high cost and side effects. Nanotechnology offers promising alternative strategies for the diagnosis and treatment of CHD by exploiting the unique properties of nanomaterials. In this review, we use bibliometric analysis to identify research hotspots in the application of nanotechnology in CHD and provide a comprehensive overview of the current state of the art. Nanomaterials with enhanced imaging and biosensing capabilities can improve the early detection of CHD through advanced contrast agents and high-resolution imaging techniques. Moreover, nanomaterials can facilitate targeted drug delivery, tissue engineering and modulation of inflammation and oxidative stress, thus addressing multiple aspects of CHD pathophysiology. We discuss the application of nanotechnology in CHD diagnosis (imaging and sensors) and treatment (regulation of macrophages, cardiac repair, anti-oxidative stress), and provide insights into future research directions and clinical translation. This review serves as a valuable resource for researchers and clinicians seeking to harness the potential of nanotechnology in the management of CHD. STATEMENT OF SIGNIFICANCE: Coronary heart disease (CHD) is the one of leading cause of death and disability worldwide. Nanotechnology offers new strategies for diagnosing and treating CHD by exploiting the unique properties of nanomaterials. This review uses bibliometric analysis to uncover research trends in the use of nanotechnology for CHD. We discuss the potential of nanomaterials for early CHD detection through advanced imaging and biosensing, targeted drug delivery, tissue engineering, and modulation of inflammation and oxidative stress. We also offer insights into future research directions and potential clinical applications. This work aims to guide researchers and clinicians in leveraging nanotechnology to improve CHD patient outcomes and quality of life.

Changes in disease-related knowledge and educational needs of patients with coronary heart disease over a six-month period between hospital discharge and follow-up.

OBJECTIVE: To describe changes in the disease-related knowledge and educational needs of individuals with coronary heart disease (CHD). METHODS: Patients hospitalized for CHD answered questionnaires about disease-related knowledge (Coronary Artery Disease Education Questionnaire-short version (CADE-Q-SV), score 0-20), educational needs (investigator-designed questions), health literacy (Short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16)), self-care (Self-Care of Coronary Heart Disease Inventory version (SC-CHDI)), and physical activity (Leisure-time Physical Activity Questionnaire) at discharge (T1) and six months later (T2). RESULTS: Participants' (N = 308; mean [M] age=65.5 years [SD=8.7]; 81.5% male) knowledge scores increased from M= 13.8 (SD=3.2) to M= 14.8 (SD=2.8) (p < 0.001). At T1, educational level, age, health literacy, smoking, and self-care maintenance explained 14.5% of knowledge variability. At T2, these variables plus lack of awareness of CHD diagnosis explained 20.3% of the variability. Substantial educational needs were reported at both time points, although 89% received predischarge education. CONCLUSION: The patients' educational needs were unfulfilled despite an increase in disease-related knowledge over time. Improved evidence-based patient education and follow-ups that address diagnosis, treatment, and self-care are needed. PRACTICE IMPLICATIONS: Healthcare professionals can improve care of patients with CHD by providing focused patient education, prioritizing "need-to-know" topics and considering patients' health literacy.

Self-Efficacy in Self-Care and Its Related Factors Among Patients with Coronary Heart Disease in Indonesia: A Rasch Analysis.

Background: Low self-efficacy (SE) can impact decreasing health status, poor self-care, and quality of life among patients with Coronary Heart Disease (CHD). Many factors can affect SE. However, studies on SE in CHD patients with Rasch Model analysis have not been carried out widely. Purpose: This study aims to identify the SE in self-care and its related factors that correlate SE among CHD patients. Patients and Methods: Cross-sectional study was conducted on 104 adult patients (≥18 years) diagnosed with CHD. Selection of the sample using convenience sampling technique with several predetermined criteria. SE was measured using the SEQ-CHDM questionnaire, with high validity and reliability results. Data were analyzed using the Rasch model and chi-square test. Results: The results showed that most respondents had a moderate SE (51.5%). Care units (p=0.003) and duration of illness (p=0.049) were significantly correlated to SE among patients with CHD. "Maintaining an ideal body weight" is the most challenging thing. On the other hand, stop smoking is the most confident thing to be performed by the respondents. Conclusion: We conclude that CHD patients in the acute care unit and patients with a duration of illness >6 months have a lower tendency for SE. Health interventions such as raising awareness about the disease, modifying health behavior, and immediately screening can improve patients' SE. Besides that, proper diagnosis and ongoing treatment are crucial to improving SE and CHD care outcomes.

Effects of nursing intervention based on a positive motivational model on cardiac function, self-management and quality of life in elderly patients with coronary heart disease.

OBJECTIVE: The aim of this study was to analyze the effects of nursing intervention based on a positive motivational model on cardiac function, self-management, and life quality in elderly patients with coronary heart disease (CHD). PATIENTS AND METHODS: A total of 112 elderly CHD patients were picked as the subjects of this research from August 2021 to August 2022. All patients were randomized to the observation group and regular group by a two-color sampling method, with 56 cases in each group. Subjects in the regular group and observation group received traditional interventions and additional positive motivational model nursing interventions, respectively. The cardiac function [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD)], sports endurance, self-management ability, psychological status [depression self-assessment scale (SDS), anxiety self-assessment scale (SAS)], and life quality before and after the intervention were compared between two groups. The readiness for discharge scores and satisfaction with nursing care were compared between the two groups after the intervention. RESULTS: After the intervention, the LVEF levels of the patients in both groups were elevated, and the LVESD and LVEDD levels were sharply decreased (p < 0.05). The improvement in cardiac function indexes was more evident in the observation group than in the regular group (p < 0.001). The readiness for discharge score of patients was markedly higher in the observation group than in the regular group (p < 0.01). After the intervention, the self-management score and sports endurance score of patients in both groups were evidently elevated (p < 0.05), which were much higher in the observation group than in the control (p < 0.001). The nursing satisfaction of patients in the observation group was 92.86%, much higher than 73.21% in the regular group (p < 0.05). The observation group had much lower SDS and SAS scores than the regular group after the intervention (p < 0.001). After the intervention, the observation group had a much higher life quality score than the regular group (p < 0.001). CONCLUSIONS: The nursing intervention model based on the positive motivation model could significantly improve the cardiac function, discharge readiness, sports endurance, and self-management behavior of elderly patients with CHD, thereby improving their quality of life and achieving higher patient satisfaction.

Prognosis of coronary heart disease after percutaneous coronary intervention: a bibliometric analysis over the period 2004-2022.

BACKGROUND: As the complexity and diversity of the percutaneous coronary intervention (PCI) are being explored and reported, burgeoning research has progressed in this field. However, there is no comprehensive analysis available on PCI-related studies published in the literature. This study aimed to analyze and visualize the changes of scientific output regarding prognosis of coronary heart disease (CHD) after PCI over the past 20 years and to reveal the knowledge domain and development trends in this field by using CiteSpace software. METHODS: Relevant articles published over the period 2004-2022 were retrieved from the Web of Science Core Collection database. After manual selection, qualified documents were included and recorded with the information of their title, abstract, keyword, author, descriptor, citation, identifier, publishing year and publishing organization. We transferred the data to CiteSpace V5.8.R2 (Version 5.8.R2) to draw knowledge maps and to conduct co-occurrence analysis, cluster analysis, timeline analysis, burst term detection and citation analysis. RESULTS: A total of 14,699 literature records were found relating prognosis of CHD after PCI in the past 20 years (2004-2022), including 14,212 original articles and reviews, and they were published in 153 different journals. Publication production has increased annually and a total of 1182 authors, 796 institutes and 147 countries have contributed to these publications. Moreover, the most representative author was Gregg W Stone from the CardioVascular Research Foundation (CVRF) with 368 publications, whose team mainly focused on exploring the efficacy and safety of revascularization and the characteristics of susceptible population. The global productivity ranking was led by the USA with 3326 published papers, followed by Italy (n = 1355), Japan (n = 1080), China (n = 1075) and Germany (n = 937). And the keywords of these publications were "percutaneous coronary intervention" (n = 2271), "outcome" (n = 1756), "mortality" (n = 1730) and "impact" (n = 1334). Other commonly-used words were "predictor" (n = 1324), "intervention" (n = 1310), "angioplasty" (n = 1299), "risk" (n = 1144), "acute myocardial infarction" (n = 1136) and "artery disease" (n = 1098). Cluster analysis showed that 15 high connected clusters were generated with a modularity Q of 0.831 and a weighted mean silhouette of 0.9388 by applying the log-likelihood ratio algorithm, and the top 5 clusters were #0 optical coherence tomography, #1 dual antiplatelet therapy, #2 bleeding, #3 clopidogrel and #4 thrombus aspiration. Furthermore, the frontiers in the field of prognosis of CHD after PCI mainly involved "decision making", "reperfusion", "angioplasty", "balloon", "unstable angina", "dual antiplatelet therapy", "cardiac surgical score", "restenosis", "reperfusion", "thrombolytic therapy", etc. CONCLUSIONS: To sum up, efficacy and safety of different types of stents, the risk factors of restenosis and thrombotic events after PCI, early risk assessment, and secondary prevention and complications of patients with CHD after PCI were research hotspots and frontier topics in the area by bibliometric analysis. The results could provide a comprehensive overview of the research hotspots and frontier topics relating prognosis of CHD after PCI, promoting a better understanding of the knowledge domain and development trends in this field during the past 20 years.

The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know.

PURPOSE OF REVIEW: Coronary heart disease (CHD) is the leading cause of morbidity, mortality, and disability in the Middle East and North Africa (MENA). While the prevention, diagnosis, and management of CHD have been detailed in international guidelines, we aimed in this review to quantify the pandemic of CHD in the MENA region and highlight regional patient characteristics, clinical challenges, and future directions to optimize CHD care in the region. RECENT FINDINGS: Patients with CHD in the MENA feature younger age at presentation and worse prognosis in women. Despite the high burden of CHD risk factors, many of these factors remain underrecognized, undertreated, and uncontrolled. Additionally, CHD care is hampered by poor patient awareness, inefficient preventive strategies, and limited access to guideline-recommended therapeutics. All stakeholders involved in healthcare should work together to develop and execute strategies aimed at tackling the burden of CHD in the MENA.

Claims data analysis of the health care utilization for patients with coronary heart disease and mental comorbidity.

OBJECTIVE: Mental disorders (MD) are a common comorbidity in patients with coronary heart disease (CHD) and have a significant impact on morbidity and mortality. The aim of this study was to determine to what extent mental disorders are diagnosed as comorbidity in patients with CHD and whether adequate therapeutic measures are taken. METHODS: Claims data from 4435 Cologne citizens with diagnosed CHD and a hospital stay due to CHD in 2015 were examined through a longitudinal analysis. The data were analyzed descriptively with regard to mental disorders, investigating diagnostic examinations performed, prescriptions for psychotropic drugs, and utilization of psychotherapy. We differentiated between pre-existing MD, existing in the year before the CHD-related hospital stay, and incident MD with new onset during or within six months after hospitalization. RESULTS: Psychodiagnostic examinations for mental disorders occurred very rarely during cardiological hospitalization (0.04%) and psychiatric/psychosomatic consultation sessions rarely (5%). The longitudinal analysis showed a high rate of pre-existing MDs (56%, n = 2490) and a new diagnosis of mental disorders in 7% (n = 302) of the patients. Within one year after inpatient treatment for CHD, psychotropic medication was prescribed in 64-67% of patients with newly diagnosed affective or neurotic, adjustment/somatoform disorder and 10-13% received outpatient psychotherapy. CONCLUSION: The results indicate low rates of inpatient diagnostic examinations and low rates of adequate treatment of mental disorders in patients from Cologne with CHD and new onset mental disorders. The rate of prescriptions of psychopharmacotherapy after hospitalization due to CHD exceeds that of the utilization of outpatient psychotherapy.