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Arnold SV, Jones PG, Maron DJ, Cohen DJ, Mark DB, Reynolds HR, Bangalore S, Chen J, Newman JD, Harrington RA, Stone GW, Hochman JS, Spertus JA. Variation in Health Status With Invasive vs Conservative Management of Chronic Coronary Disease. J Am Coll Cardiol 2024; 83:1353-1366. [PMID: 38599711 DOI: 10.1016/j.jacc.2024.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The ISCHEMIA trial found that patients with chronic coronary disease randomized to invasive strategy had better health status than those randomized to conservative strategy. It is unclear how best to translate these population-level results to individual patients. OBJECTIVES The authors sought to identify patient characteristics associated with health status from invasive and conservative strategies, and develop a prediction algorithm for shared decision-making. METHODS One-year disease-specific health status was assessed in ISCHEMIA with the Seattle Angina Questionnaire (SAQ) Summary Score (SAQ SS) and Angina Frequency, Physical Limitations (PL), and Quality of Life (QL) domains (range 0-100, higher = less angina/better health status). RESULTS Among 4,617 patients from 320 sites in 37 countries, mean SAQ SS was 74.1 ± 18.9 at baseline and 85.7 ± 15.6 at 1 year. Lower baseline SAQ SS and younger age were associated with better 1-year health status with invasive strategy (P interaction = 0.009 and P interaction = 0.004, respectively). For the individual domains, there were significant treatment interactions for baseline SAQ score (Angina Frequency, PL), age (PL, QL), anterior ischemia (PL), and number of baseline antianginal medications (QL), with more benefit of invasive in patients with worse baseline health status, younger age, anterior ischemia, and on more antianginal medications. Parsimonious prediction models were developed for 1-year SAQ domains with invasive or conservative strategies to support shared decision-making. CONCLUSIONS In the management of chronic coronary disease, individual patient characteristics are associated with 1-year health status, with younger age and poorer angina-related health status showing greater benefit from invasive management. This prediction algorithm can support the translation of the ISCHEMIA trial results to individual patients. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
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Affiliation(s)
- Suzanne V Arnold
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
| | - Philip G Jones
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - David J Maron
- Stanford University Department of Medicine, Stanford, California, USA
| | - David J Cohen
- St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Daniel B Mark
- Duke Clinical Research Institute and Duke University, Durham, North Carolina, USA
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, New York, USA
| | - Sripal Bangalore
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, New York, USA
| | - Jiyan Chen
- Guangdong General Hospital, Guangzhou, China
| | - Jonathan D Newman
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, New York, USA
| | | | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York, USA; Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith S Hochman
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, New York, USA
| | - John A Spertus
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
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2
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 110] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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3
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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4
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Saeed N, Norekvål TM, Steiro OT, Tjora HL, Langørgen J, Bjørneklett RO, Skadberg Ø, Bonarjee VVS, Mjelva ØR, Omland T, Vikenes K, Aakre KM. Predictors of long-term symptom burden and quality of life in patients hospitalised with chest pain: a prospective observational study. BMJ Open 2022; 12:e062302. [PMID: 35831040 PMCID: PMC9280876 DOI: 10.1136/bmjopen-2022-062302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To describe the magnitude and predictors of symptom burden (SB) and quality of life (QoL) 3 months after hospital admission for acute chest pain. DESIGN Prospective observational study. SETTING Single centre, outpatient follow-up. PARTICIPANTS 1506 patients. OUTCOMES Scores reported for general health (RAND-12), angina-related health (Seattle Angina Questionnaire 7 (SAQ-7)) and dyspnoea (Rose Dyspnea Scale) 3 months after hospital admission for chest pain. METHODS A total of 1506 patients received questionnaires assessing general health (RAND-12), angina-related health (SAQ-7) and dyspnoea (Rose Dyspnea Scale) 3 months after discharge. Univariable and multivariable regression models identified predictors of SB and QoL scores. A mediator analysis identified factors mediating the effect of an unstable angina pectoris (UAP) diagnosis. RESULTS 774 (52%) responded. Discharge diagnoses were non-ST elevation myocardial infarction (NSTEMI) (14.2%), UAP (17.1%), non-coronary cardiac disease (6.6%), non-cardiac disease (6.3%) and non-cardiac chest pain (NCCP) (55.6%). NSTEMI had the most favourable, and UAP patients the least favourable SAQ-7 scores (median SAQ7-summary; 88 vs 75, p<0.001). NCCP patients reported persisting chest pain in 50% and dyspnoea in 33% of cases. After adjusting for confounders, revascularisation predicted better QoL scores, while UAP, current smoking and hypertension predicted worse outcome. NSTEMI and UAP patients who were revascularised reported higher scores (p<0.05) in SAQ-7-QL, SAQ7-PL, SAQ7-summary (NSTEMI) and all SAQ-7 domains (UAP). Revascularisation altered the unstandardised beta value (>±10%) of an UAP diagnosis for all SAQ-7 and RAND-12 outcomes. CONCLUSIONS Patients with NSTEMI reported the most favourable outcome 3 months after hospitalisation for chest pain. Patients with other diseases, in particular UAP patients, reported lower scores. Revascularised NSTEMI and UAP patients reported higher QoL scores compared with patients receiving conservative treatment. Revascularisation mediated all outcomes in UAP patients. TRIAL REGISTRATION NUMBER NCT02620202.
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Affiliation(s)
- Nasir Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ole-Thomas Steiro
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Hilde Lunde Tjora
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Oskar Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Øyvind Skadberg
- Laboratory of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Torbjørn Omland
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Oslo, Norway
| | - Kjell Vikenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kristin Moberg Aakre
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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5
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Kähkönen O, Oikarinen A, Vähänikkilä H, Kyngäs H. Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long-term follow-up study. J Adv Nurs 2022; 78:1653-1664. [PMID: 34636444 DOI: 10.1111/jan.15069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/16/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022]
Abstract
AIMS To identify associations between perceived health and treatment adherence six years after percutaneous coronary intervention. DESIGN A non-experimental descriptive long-term follow-up study. METHODS Baseline data (n = 416) were collected in 2013, with follow-up data collected in 2019 (n = 154), using the EuroQoL scale, EuroQoL visual analogue scale, and Adherence of Patients with Chronic Disease Instrument. Data were analysed using descriptive statistics and multivariate methods. RESULTS The average age of the 154 respondents was 68.5 years (SD 7.01), with a majority males (n = 118, 86.6%). Adherence to a healthy lifestyle, good perceived results of care, support from nurses, high sense of normality, low fear of complications, motivation, older age, and duration of coronary artery disease were associated with better general perceived health as well as its dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). CONCLUSION Support from nurses is a key factor to ensuring high perceived health among post-percutaneous coronary intervention patients. This support must be continuous and motivate the patient to adhere to a healthy lifestyle. Patients should feel comfortable sharing their problems and fears. This type of relationship will allow health care professionals to assess the patient's current situation and address potential problems about mobility, pain and discomfort, as well as anxiety and depression to strengthen the patient's sense of normality and enable them to confidently lead a normal life. IMPACT The research aimed to gain knowledge about how perceived health is associated with treatment adherence six years after percutaneous coronary intervention. The results emphasise that a nurse's support of patients is crucial to the care process, as adherence to treatment showed a clear positive association with perceived health in the analysed sample of post-PCI patients.
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Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure of Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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6
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DeVon HA, Uwizeye G, Cai HY, Shroff AR, Briller JE, Ardati A, Hoppensteadt D, Rountree L, Schlaeger JM. Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population. Acupunct Med 2021; 40:152-159. [PMID: 34856826 DOI: 10.1177/09645284211055754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Stable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL). METHODS Participants with stable angina for ⩾1 month received either a standardized acupuncture protocol, twice per week for 5 weeks, or an attention control protocol. Measures included the McGill Pain Questionnaire (average pain intensity (API), pain now) and the Seattle Angina Questionnaire-7 (functional status, symptoms, and HRQoL). Feasibility was defined as ⩾80% recruitment, ⩾75% retention following enrollment, and ⩾80% completion. Descriptive statistics and mixed-effects linear regression were used for analysis. RESULTS The sample (n = 24) had a mean age of 59 ± 12 years, was predominantly female (63%), and represented minority groups (8% White, 52% Black, 33% Hispanic, and 8% Other). Feasibility was supported by 79% retention and 89% completion rates. The recruitment rate (68%) was slightly lower than expected. Acceptability scores were 87.9% for the acupuncture group and 51.7% for the control group. Outcomes were significantly better for the acupuncture versus control groups (API, b = -2.1 (1.1), p = 0.047; functional status, b = 27.6 (7.2), p < 0.001; and HRQoL, b = 38.8 (11.9), p = 0.001). CONCLUSIONS AND IMPLICATIONS Acupuncture was feasible and acceptable in our diverse sample. We were slightly under the recruitment target of 80%, but participants who started the study had a high likelihood of completing it. Acupuncture shows promise for stable angina, but its effectiveness needs to be confirmed by a larger, adequately powered RCT. TRIAL REGISTRATION NUMBER NCT02914834 (ClinicalTrials.gov).
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Affiliation(s)
- Holli A DeVon
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Glorieuse Uwizeye
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Hui Yan Cai
- Department of Acupuncture and Oriental Medicine, National University of Health Sciences, Lombard, IL, USA
| | - Adhir R Shroff
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Joan E Briller
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Amer Ardati
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Lauren Rountree
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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7
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Creber RM, Dimagli A, Spadaccio C, Myers A, Moscarelli M, Demetres M, Little M, Fremes S, Gaudino M. Effect of coronary artery bypass grafting on quality of life: a meta-analysis of randomized trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:259-268. [PMID: 34643672 PMCID: PMC9071531 DOI: 10.1093/ehjqcco/qcab075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 01/09/2023]
Abstract
AIMS We conducted a systematic review and meta-analysis to evaluate temporal trends in quality of life (QoL) after coronary artery bypass grafting (CABG) surgery in randomized clinical trials, and a quantitative comparison from before surgery to up to 5 years after surgery. METHODS AND RESULTS We searched MEDLINE, CINAHL, EMBASE, Cochrane Library, and PsycINFO from 2010 to 2020 to identify studies that included the measurement of QoL in patients undergoing CABG. The primary outcome was the Seattle Angina Questionnaire (SAQ), and secondary outcomes were the 36-item Short Form Health Survey (SF-36) and EuroQol Questionnaire (EQ-5D). We pooled the means and the weighted mean differences over the follow-up period. In the meta-analysis, 2586 studies were screened and 18 full-text studies were included. There was a significant trend towards higher QoL scores from before surgery to 1 year post-operatively for the SAQ angina frequency (AF), SAQ QoL, SF-36 physical component (PC), and EQ-5D, whereas the SF-36 mental component (MC) did not improve significantly. The weighted mean differences from before surgery to 1 year after was 24 [95% confidence interval (CI): 21.6-26.4] for the SAQ AF, 31 (95% CI: 27.5-34.6) for the SAQ QoL, 9.8 (95% CI: 7.1-12.8) for the SF-36 PC, 7.1 (95% CI: 4.2-10.0) for the SF-36 MC, and 0.1 (95% CI: 0.06-0.14) for the EQ-5D. There was no evidence of publication bias or small-study effect. CONCLUSION CABG had both short- and long-term improvements in disease-specific QoL and generic QoL, with the largest improvement in angina frequency.
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Affiliation(s)
| | | | - Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK,Lancashire Cardiac Center, Blackpool Victoria Teaching Hospital, Blackpool, UK
| | - Annie Myers
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Marco Moscarelli
- Department of Cardiac Surgery, Imperial College London, London, UK
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY USA
| | - Matthew Little
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Stephen Fremes
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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8
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Public Health and Economic Benefits of Influenza Vaccination of the Population Aged 50 to 59 Years without Risk Factors for Influenza Complications in Mexico: A Cross-Sectional Epidemiological Study. Vaccines (Basel) 2021; 9:vaccines9030188. [PMID: 33668199 PMCID: PMC7995959 DOI: 10.3390/vaccines9030188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
The Mexican influenza vaccination program does not include a recommendation for people aged 50–59 years without risk factors for influenza complications, and there are limited data regarding the cost-effectiveness of vaccinating this population. To explore the clinical and economic effects of including this population in the vaccination schedule, we performed a cross-sectional epidemiological study using records (2009–2018) from Mexico’s Influenza Surveillance System (SISVEFLU), death records (2010–2015) from the National Mortality Epidemiological and Statistical System, and discharge and hospitalization records (2010–2015) from the Automated Hospital Discharge System databases. A 1-year decision-analytic model was used to assess cost-effectiveness through a decision-tree based on data from SISVEFLU. The primary outcome was influenza cases avoided; with associated influenza-related events as secondary outcomes. Including the population aged 50–59 years without risk factors in Mexico’s influenza immunization program would have resulted in 199,500 fewer cases; 67,008 fewer outpatient consultations; 33,024 fewer emergency room consultations; 33,091 fewer hospitalizations; 12 fewer deaths. These reductions equate to a substantial public health benefit as well as an economic benefit; yielding net savings of 49.8 million US dollars over a typical influenza season. Expansion of the current Mexican vaccination schedule to include these people would be a cost-saving and dominant strategy.
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9
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Saxon JT, Grantham JA, Salisbury AC, Sapontis J, Lombardi WL, Karmpaliotis D, Moses J, Nicholson WJ, Tang Y, Cohen DJ, Spertus JA, Safley DM. Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry. Circ Cardiovasc Interv 2020; 13:e008448. [PMID: 32069112 DOI: 10.1161/circinterventions.119.008448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American College of Cardiology/American Heart Association Appropriate Use Criteria were designed to aid clinical decision-making, yet their association with health status outcomes after chronic total occlusion percutaneous coronary intervention (PCI) is unknown. METHODS We analyzed 769 patients with baseline and 1-year health status data after chronic total occlusion PCI. Procedures were categorized as appropriate, may be appropriate, or rarely appropriate. Mean changes in patient-reported health status, assessed by the Seattle Angina Questionnaire (SAQ), were compared across appropriate use criteria categories from baseline to 1 year. Change in SAQ summary score was stratified as little to no benefit (≤10 points), intermediate (10-19 points), large (20-29 points), and very large (≥30 points). RESULTS The appropriate use criteria indication was appropriate in 573 patients (74.5%), may be appropriate in 191 (24.8%), and rarely appropriate in 5 (0.7%). Patients in the appropriate group reported greater improvement in SAQ summary scores (27.3±21.3 points) at 1 year compared with the may be appropriate (22.5±20.9; P=0.01). A similar pattern was noted for SAQ angina frequency (mean change 24.0±27.2 versus 18.7±25.6; P=0.02). The appropriate group had the highest proportion of very large improvements in SAQ summary scores (44.5% versus 33.3%; P=0.01). CONCLUSIONS Among patients undergoing chronic total occlusion PCI, the rate of rarely appropriate PCI was low. The rate of appropriate PCI was high and was associated with the greatest health status improvement at 1 year. A substantial proportion of patients in the may be appropriate group experienced meaningful health status benefits as well.
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | | | | | | | - Jeffery Moses
- Columbia University Medical Center/New York-Presbyterian Hospital (D.K., J.M.)
| | | | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
| | - David M Safley
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).,University of Missouri-Kansas City (J.T.S., J.A.G., A.C.S., D.J.C., J.A.S., D.M.S.)
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10
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Qintar M, Hirai T, Arnold SV, Sheehy J, Sapontis J, Jones P, Tang Y, Lombardi W, Karmpaliotis D, Moses J, Patterson C, Nicholson WJ, Cohen DJ, Spertus JA, Grantham JA, Salisbury AC. De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status. Am Heart J 2019; 214:1-8. [PMID: 31152872 DOI: 10.1016/j.ahj.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status. METHODS In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation. RESULTS Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, P = .43; any dyspnea: 51.8% vs 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months. CONCLUSIONS Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1 month and was not associated with worse long-term health status.
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11
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Particularities of Acute Myocardial Infarction in Young Adults. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.
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12
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Kim HS, Kim HK, Kang KO, Kim YS. Determinants of health-related quality of life among outpatients with acute coronary artery disease after percutaneous coronary intervention. Jpn J Nurs Sci 2018; 16:3-16. [DOI: 10.1111/jjns.12209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/19/2017] [Accepted: 01/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hee Sun Kim
- College of Nursing, Research Institute of Nursing Science; Chonbuk National University; Jeonju South Korea
| | - Hyun Kyung Kim
- College of Nursing, Research Institute of Nursing Science; Chonbuk National University; Jeonju South Korea
| | - Kyung Ok Kang
- Chonbuk National University Hospital; Jeonju South Korea
| | - Yi Sik Kim
- Division of Cardiology, Department of Internal Medicine; Chonbuk National University Hospital; Jeonju South Korea
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13
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Kang K, Gholizadeh L, Inglis SC, Han HR. Correlates of health-related quality of life in patients with myocardial infarction: A literature review. Int J Nurs Stud 2017; 73:1-16. [PMID: 28511032 DOI: 10.1016/j.ijnurstu.2017.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND By the increasing emphasis on health-related quality of life (HRQoL) in patients with myocardial infarction (MI), it is necessary to explore factors that affect HRQoL in this population. OBJECTIVES This study aimed to identify correlates of HRQoL in patients with MI. DESIGN A literature review of the factors that affect HRQoL in patients with MI (1995-2016). DATA SOURCES Three main databases-CINAHL, MEDLINE and PsychINFO-were searched to retrieve relevant peer-reviewed articles published in English. REVIEW METHODS In consultation with a medical librarian, we identified relevant MeSH terms and used them for searching the literature: health-related quality of life/quality of life/HRQoL/QoL, myocardial infarction/heart attack/MI and predict*/factor. Data elements were extracted and narratively described variables synthesised into four categories. RESULTS A total of 48 studies met the inclusion criteria and were included in the review. Correlates of HRQoL in patients with MI were identified in the following categories: demographic, behavioural, disease-related, and psychosocial factors. Specific correlates included age and gender-identity for demographic factors; physical activity and smoking for behavioural factors; severity of MI, symptoms, and comorbidities for disease-related factors; anxiety and depression for psychosocial factors. CONCLUSIONS Identifying correlates of HRQoL can help identify patients who are at risk for poor HRQoL in the recovery or rehabilitation stage of post-MI. Future intervention should focus on adjustable correlates such as behavioural and psychosocial factors to promote HRQoL among patients after experiencing MI.
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Affiliation(s)
- Kyoungrim Kang
- University of Technology Sydney, Sydney, NSW, Australia.
| | | | | | - Hae-Ra Han
- The Johns Hopkins University, Baltimore, MD, USA
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14
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Qintar M, Spertus JA, Tang Y, Buchanan DM, Chan PS, Amin AP, Salisbury AC. Noncardiac chest pain after acute myocardial infarction: Frequency and association with health status outcomes. Am Heart J 2017; 186:1-11. [PMID: 28454822 DOI: 10.1016/j.ahj.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/01/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The frequency of noncardiac chest pain (CP) hospitalization after acute myocardial infarction (AMI) is unknown, and its significance from patients' perspectives is not studied. OBJECTIVES To assess the frequency of noncardiac CP admissions after AMI and its association with patients' self-reported health status. METHODS We identified cardiac and noncardiac CP hospitalizations in the year after AMI from the 24-center TRIUMPH registry. Hierarchical repeated-measures regression was used to identify the association of these hospitalizations with patients' self-reported health status using the Seattle Angina Questionnaire Quality of Life domain (SAQ QoL) and Short Form 12 (SF-12) physical (PCS) and mental (MCS) component summary scores. RESULTS Of 3,099 patients, 318 (10.3%) were hospitalized with CP, of whom 92 (28.9%) were hospitalized for noncardiac CP. Compared with patients not hospitalized with CP, noncardiac CP hospitalization was associated with poorer health status (SAQ QoL-adjusted differences: -8.9 points [95% CI -12.1 to -5.6]; SF-12 PCS: -2.5 points [95% CI -4.2 to -0.8] and SF-12 MCS: -3.5 points [95% CI -5.1 to -1.9]). The SAQ QoL for patients hospitalized with noncardiac CP was similar to patients hospitalized with cardiac CP (adjusted difference: 0.6 points [95% CI -3.2 to 4.5]; SF-12 PCS (0.9 points [95% CI -1.1 to 2.9]), but was worse with regard to SF-12 MCS (adjusted difference: -2.0 points [95% CI -3.9 to -0.2]). CONCLUSIONS Noncardiac CP accounted for a third of CP hospitalizations within 1 year of AMI and was associated with similar disease-specific QoL as well as general physical and mental health status impairment compared with cardiac CP hospitalization.
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Affiliation(s)
- Mohammed Qintar
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Donna M Buchanan
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO
| | - Amit P Amin
- Washington University School of Medicine, Saint Louis, MO
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
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15
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Jamotte A, Clay E, Macabeo B, Caicedo A, Lopez JG, Bricks L, Romero Prada M, Marrugo R, Alfonso P, Moreno Arévalo B, Franco D, Garcia Diaz L, Isaza de Molto Y. Public health impact and economic benefits of quadrivalent influenza vaccine in Latin America. Hum Vaccin Immunother 2017; 13:877-888. [PMID: 28118092 PMCID: PMC5404619 DOI: 10.1080/21645515.2016.1256928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Annual trivalent influenza vaccines (TIV) containing 2 A strains and one B lineage have been recommended for the prevention of influenza in most of Latin American countries. However, the circulation of 2 B lineages (Victoria and Yamagata) and difficulties in predicting the predominating lineage have led to the development of quadrivalent influenza vaccines (QIV), including both B lineages. Thus, the objective was to estimate the public health impact and influenza-related costs if QIV would have been used instead of TIV in 3 Latin American countries. We used a static model over the seasons 2010–2014 in Brazil, 2007–2014 in Colombia and 2006–2014 in Panama, focusing on population groups targeted by local vaccination recommendations: young children, adults with risk factors and the elderly. In Brazil, between 2010 and 2014, using QIV instead of TIV would have avoided US$ 6,200 per 100,000 person-years in societal costs, based on 168 influenza cases, 89 consultations, 3.2 hospitalizations and 0.38 deaths per 100,000 person-years. In Colombia and Panama, these would have ranged from US$ 1,000 to 12,700 (based on 34 cases, 13–25 consultations, 0.6–8.9 hospitalizations and 0.04–1.74 deaths) and from US$ 3,000 to 33,700 (based on 113 cases, 55–82 consultations, 0.5–27.8 hospitalizations and 0.08–6.87 deaths) per 100,000 person-years, respectively. Overall, the broader protection offered by QIV would have reduced the influenza humanistic and economic burden in the 3 countries. Despite the lack of local data leading to several extrapolations, this study is the first to give quantitative estimates of the potential benefits of QIV in Latin America.
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Affiliation(s)
| | | | | | | | | | - Lucia Bricks
- e Sanofi Pasteur Latin America , Sao Paulo , Brazil
| | | | | | | | | | - Danilo Franco
- g The Gorgas Memorial Institute for Health Studies , Panama City , Panama
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16
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Løvlien M, Mundal L, Hall-Lord ML. Health-related quality of life, sense of coherence and leisure-time physical activity in women after an acute myocardial infarction. J Clin Nurs 2016; 26:975-982. [PMID: 27239746 DOI: 10.1111/jocn.13411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 12/26/2022]
Abstract
AIMS AND OBJECTIVES To examine the relationship between leisure-time physical activity, health-related quality of life and sense of coherence in women after an acute myocardial infarction, and further to investigate whether these aspects were associated with age. BACKGROUND Physical activity and health-related quality of life are vital aspects for patients after an acute myocardial infarction. DESIGN Cross-sectional. METHOD All eligible women diagnosed with acute myocardial infarction received a postal questionnaire two to three months after hospital discharge, and 142 women were included. To measure health-related quality of life and sense of coherence, The MacNew Heart disease questionnaire and the Sense of coherence-13 scale was used. RESULTS Respondents reporting at least one type of physical activity had significantly higher health-related quality of life as compared to respondents reporting no kind of physical activity. Respondents reporting physical activity for at least 30 minutes twice a week had significantly higher health-related quality of life scores than respondents being active less than twice a week. A weak association was found between physical activity level and sense of coherence. Reduction in physical activity after the acute myocardial infarction was associated with reduced health-related quality of life and sense of coherence. Sense of coherence was significantly associated with age, as respondents 75 years and older had significantly higher scores than respondents younger than 75 years. CONCLUSIONS Physical activity, even at a low level, is significantly associated with increased health-related quality of life and to some extent to sense of coherence. RELEVANCE TO CLINICAL PRACTICE Tailoring women after an acute myocardial infarction about lifestyle changes must include knowledge about the benefits of leisure-time physical activity, and that even a small amount of activity is associated with a better health-related quality of life. The utmost important assignment is to motivate the women for regular physical activity in their leisure-time. Older women need special attention.
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Affiliation(s)
- Mona Løvlien
- Norwegian University of Technology and Science, Gjøvik, Norway
| | - Liv Mundal
- Oslo University Hospital HF, Oslo, Norway
| | - Marie-Louise Hall-Lord
- Norwegian University of Technology and Science, Gjøvik, Norway.,Karlstad University, Karlstad, Sweden
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17
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Doll JA, Tang F, Cresci S, Ho PM, Maddox TM, Spertus JA, Wang TY. Change in Angina Symptom Status After Acute Myocardial Infarction and Its Association With Readmission Risk: An Analysis of the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) Registry. J Am Heart Assoc 2016; 5:JAHA.116.003205. [PMID: 27412898 PMCID: PMC4937266 DOI: 10.1161/jaha.116.003205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Angina is common both before and after myocardial infarction (MI). Whether the change in angina status within the first 30 days after MI is associated with subsequent readmission and angina persistence is unknown. Methods and Results We studied 2915 MI patients enrolled at 24 hospitals in the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status (TRIUMPH) registry. Angina before and 30 days after MI was assessed with the Seattle Angina Questionnaire. Patients were divided into angina‐free pre‐ and post‐MI (−/−), resolved angina (+/−), new angina (−/+), and persistent angina (+/+) groups. Multivariable proportional hazards and hierarchical modified Poisson models were performed to assess the association of each group with all‐cause readmission, readmission for MI or unplanned revascularization, and angina persistence at 1 year. Overall, 1293 patients (44%) had angina before their MI and 849 (29%) reported angina within 30 days of discharge. Patients with post‐MI angina were more likely to be younger, nonwhite, and uninsured. Compared with patients who were angina‐free pre‐ and post‐MI, 1‐year all‐cause readmission risks were significantly higher for patients with persistent angina (hazard ratio [HR], 1.35; 95% CI 1.06–1.71) or new angina (HR, 1.40; 95% CI, 1.08–1.82). At 1 year, angina was present in 22% of patients and was more likely if angina was persistent (HR, 3.55; 95% CI, 3.05–4.13) or new (HR, 3.38; 95% CI, 2.59–4.42) at 30 days compared with patients who were angina‐free pre‐ and post‐MI. Conclusions Post‐MI angina, whether new or persistent, is associated with higher likelihood of readmission. Prioritizing post‐MI angina management is a potential means of improving 1‐year outcomes.
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Affiliation(s)
- Jacob A Doll
- Duke Clinical Research Institute, Durham, NC Department of Medicine, Duke University, Durham, NC
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO University of Missouri-Kansas City, Kansas City, MO
| | - Sharon Cresci
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - P Michael Ho
- VA Eastern Colorado Health Care System, Denver, CO University of Colorado School of Medicine, Aurora, CO
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System, Denver, CO University of Colorado School of Medicine, Aurora, CO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO University of Missouri-Kansas City, Kansas City, MO
| | - Tracy Y Wang
- Duke Clinical Research Institute, Durham, NC Department of Medicine, Duke University, Durham, NC
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18
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Shah N, Kelly AM, Cox N, Wong C, Soon K. Myocardial Infarction in the "Young": Risk Factors, Presentation, Management and Prognosis. Heart Lung Circ 2016; 25:955-60. [PMID: 27265644 DOI: 10.1016/j.hlc.2016.04.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/31/2015] [Accepted: 04/10/2016] [Indexed: 12/15/2022]
Abstract
Myocardial infarction (MI) in the "young" is a significant problem, however there is scarcity of data on premature coronary heart disease (CHD) and MI in the "young". This may lead to under-appreciation of important differences that exist between "young" MI patients versus an older cohort. Traditional differences described in the risk factor profile of younger MI compared to older patients include a higher prevalence of smoking, family history of premature CHD and male gender. Recently, other potentially important differences have been described. Most "young" MI patients will present with non-ST elevation MI but the proportion presenting with ST-elevation MI is increasing. Coronary angiography usually reveals less extensive disease in "young" MI patients, which has implications for management. Short-term prognosis of "young" MI patients is better than for older patients, however contemporary data raises concerns regarding longer-term outcomes, particularly in those with reduced left ventricular systolic function. Here we review the differences in rate, risk factor profile, presentation, management and prognosis between "young" and older MI patients.
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Affiliation(s)
- Nadim Shah
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia.
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Vic, Australia
| | - Nicholas Cox
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Chiew Wong
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Kean Soon
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
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19
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Arnold SV, Jang JS, Tang F, Graham G, Cohen DJ, Spertus JA. Prediction of residual angina after percutaneous coronary intervention. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2015; 1:23-30. [PMID: 29474572 DOI: 10.1093/ehjqcco/qcv010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Indexed: 11/14/2022]
Abstract
Aims Angina relief is a major goal of percutaneous coronary intervention (PCI); however, about one in five patients continue to have angina after PCI. Understanding patient factors associated with residual angina would enable providers to more accurately calibrate patients' expectations of angina relief after PCI, may support different follow-up strategies or approaches to coronary revascularization, and could potentially serve as a marker of PCI quality. Methods and results Among 2573 patients who had PCI at 10 US hospitals for stable angina, unstable angina, or non-ST-elevation myocardial infarction (NSTEMI), 24% reported angina 6 months after PCI, as assessed with the Seattle Angina Questionnaire angina frequency score (categorized as none vs. any angina; score = 100 vs. <100). Post-PCI angina was more common in those patients treated for unstable angina (30 vs. 20% stable angina and 21% NSTEMI, P < 0.001). Using a hierarchical logistic regression model, eight variables were independently associated with angina after PCI, including younger age, poor economic status, depression, and greater number of antianginal medications at the time of PCI (c-index = 0.75). The amount of angina at the time of PCI was more predictive of post-PCI angina in patients with stable or unstable angina when compared with NSTEMI (pinteraction = 0.01). The model demonstrated excellent calibration, both in the original sample (slope 1.04, intercept -0.01, r = 0.98) and in bootstrap validation. Conclusion Based on a large, multicentre cohort of PCI patients, we created a model of residual angina 6 months after PCI that can provide patients realistic expectations of angina relief, guide follow-up strategies, support the use of residual angina as a means of comparing PCI quality, and enable comparative effectiveness research.
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jae-Sik Jang
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA.,University of Missouri-Kansas City, Kansas City, MO, USA.,Inje University Busan Paik Hospital, Busan, Korea
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
| | | | - David J Cohen
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA.,University of Missouri-Kansas City, Kansas City, MO, USA
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20
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Boateng GO, Luginaah IN, Taabazuing MM. Examining the Risk Factors Associated With Hypertension Among the Elderly in Ghana. J Aging Health 2015; 27:1147-69. [PMID: 25818146 DOI: 10.1177/0898264315577588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study sought to examine the risk factors associated with hypertension among the elderly in Ghana. We focused on the association between chronic diseases, socioeconomic factors, and being hypertensive. METHOD Data for the study were drawn from Wave 1 of the 2007/2008 Ghana Study on Global Ageing and Adult Health (SAGE). A binary logit model was used to estimate the effect of other noncommunicable diseases, psychosocial factors, lifestyle factors, and sociocultural and biosocial factors on the elderly being hypertensive. RESULTS Elderly Ghanaians who had been diagnosed with arthritis, angina, diabetes, and asthma were significantly more likely to be hypertensive. Additionally, those depressed were found to be 1.22 times more likely to be hypertensive. DISCUSSION Prevention and control of hypertension are complex and demand multistakeholder collaboration including governments, educational institutions, media, food and beverage industry, and a conscious focus on personal lifestyle factors.
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Chan PS, Jones PG, Arnold SA, Spertus JA. Development and validation of a short version of the Seattle angina questionnaire. Circ Cardiovasc Qual Outcomes 2014; 7:640-7. [PMID: 25185249 DOI: 10.1161/circoutcomes.114.000967] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials and national performance measures increasingly mandate reporting patients' perspectives of their health status: their symptoms, function, and quality of life. Although the Seattle Angina Questionnaire (SAQ) is a validated disease-specific health status instrument for coronary artery disease (CAD) with high test-retest reliability, predictive power, and responsiveness, its use in routine clinical practice has been limited, in part, by its length (19 items). METHODS AND RESULTS Using data from 10 408 patients with CAD from 5 multicenter registries, we derived and validated a shortened version of the SAQ (SAQ-7) among patients presenting with stable CAD, undergoing percutaneous coronary intervention, and after acute myocardial infarction. We examined the psychometric properties of the SAQ-7 as compared with the full SAQ. Seven items from the Physical Limitation, Angina Frequency, and Quality of Life domains were identified for the SAQ-7, with high levels of concordance (0.88-1.00) with each original SAQ domain. The SAQ-7 demonstrated good construct validity (compared with Canadian Cardiovascular Society class for angina), with a correlation of 0.62 and 0.38 for patients with stable CAD and undergoing percutaneous coronary intervention, respectively. It was highly reproducible in patients with stable CAD (intraclass correlation, ≥0.78) and exhibited excellent responsiveness in patients after percutaneous coronary intervention (≥18 points in each SAQ domain). Finally, the SAQ-7 was predictive of 1-year mortality and readmission. CONCLUSIONS To increase the feasibility of measuring patient-reported outcomes in patients with CAD, we developed and validated a shortened 7-item SAQ instrument for use in clinical trials and routine care.
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Affiliation(s)
- Paul S Chan
- From the Department of Internal Medicine, Mid-America Heart Institute, Kansas City, MO (P.S.C., P.G.J., S.A.A., J.A.S.); and the Department of Internal Medicine, University of Missouri, Kansas City (P.S.C., S.A.A., J.A.S.).
| | - Philip G Jones
- From the Department of Internal Medicine, Mid-America Heart Institute, Kansas City, MO (P.S.C., P.G.J., S.A.A., J.A.S.); and the Department of Internal Medicine, University of Missouri, Kansas City (P.S.C., S.A.A., J.A.S.)
| | - Suzanne A Arnold
- From the Department of Internal Medicine, Mid-America Heart Institute, Kansas City, MO (P.S.C., P.G.J., S.A.A., J.A.S.); and the Department of Internal Medicine, University of Missouri, Kansas City (P.S.C., S.A.A., J.A.S.)
| | - John A Spertus
- From the Department of Internal Medicine, Mid-America Heart Institute, Kansas City, MO (P.S.C., P.G.J., S.A.A., J.A.S.); and the Department of Internal Medicine, University of Missouri, Kansas City (P.S.C., S.A.A., J.A.S.)
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22
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Soo Hoo SY, Gallagher R, Elliott D. Systematic review of health-related quality of life in older people following percutaneous coronary intervention. Nurs Health Sci 2014; 16:415-27. [PMID: 24779852 DOI: 10.1111/nhs.12121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 11/10/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
People aged over 60 years represent an increasingly high proportion of the population undergoing percutaneous coronary intervention. While risks are greater for older people in terms of major adverse cardiovascular events and higher mortality for this treatment, it is unclear if the benefits of health-related quality of life outcomes may outweigh risks. A search of the PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica, and Cochrane databases was conducted for the period from January 1999 to June 2012 using key words "percutaneous coronary intervention"/"angioplasty," "older," "elderly," and "quality of life"/"health-related quality of life." Using a systematic review approach, data from 18 studies were extracted for description and synthesis. Findings revealed that everyone regardless of age reported better health-related quality of life, primarily from the relief of angina and improved physical and mental function. Age itself did not have an independent predictive effect when other factors such as comorbid conditions were taken into account. Assessment of older peoples' health status following percutaneous coronary intervention by nurses and other health professionals is therefore important for the provision of quality care.
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Affiliation(s)
- Soon Yeng Soo Hoo
- Faculty of Health, University of Technology, Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
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Cognitive-affective symptoms of depression after myocardial infarction: different prognostic importance across age groups. Psychosom Med 2013; 75:701-8. [PMID: 23873711 DOI: 10.1097/psy.0b013e31829dbd36] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cognitive-affective symptoms of depression may not be as strongly related to prognosis after myocardial infarction (MI) as somatic depressive symptoms. Because it is not known whether this pattern of results is influenced by the age at which patients are diagnosed as having MI, we examined whether the importance of these symptoms is age dependent in the Enhancing Recovery in Coronary Heart Disease study. METHODS Patients with depression after MI (n = 1823) in the Enhancing Recovery in Coronary Heart Disease study were stratified into the following age groups: younger than 70 years (mean [standard deviation] = 55 [9.0] years) and 70 years or older (mean [standard deviation] = 76 [4.9] years). Measurements included demographic and clinical data and the Beck Depression Inventory. The end point was a composite of recurrent MI and mortality during a mean follow-up of 2.1 years. RESULTS Patients 70 years or older had more severe manifestations of cardiac disease and somatic comorbidities than did patients younger than 70 years (p < .001). During follow-up, 456 patients died or had a recurrent MI. In patients 70 years or older, increasing age, disease severity, and comorbidities--but not depressive symptoms--independently predicted prognosis. In contrast, cognitive-affective symptoms of depression predicted death/MI in patients younger than 70 years (hazard ratio = 1.03, 95% confidence interval = 1.01-1.04, p = .011), after adjustment for disease severity and comorbidities. Somatic symptoms largely explained the link between cognitive-affective symptoms and adverse events, with the exception of hopelessness (hazard ratio = 1.47, 95% confidence interval = 1.11-1.95, p = .007), suggesting that somatic depressive symptoms accurately reflect the depressed mood state in this age group. CONCLUSIONS Somatic symptoms and hopelessness independently predicted death/MI in MI patients younger than 70 years. Research needs to reexamine the modulating effect of age in studies on somatic and cognitive-affective symptoms of post-MI depression.
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Patrick AR, Franklin JM, Weinstein MC, Glynn RJ, Schneeweiss S. Sequential Value-of-Information Assessment for Prospective Drug Safety Monitoring Using Claims Databases. Med Decis Making 2013; 33:949-60. [DOI: 10.1177/0272989x13497997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Key to conducting active drug safety surveillance using longitudinal health care data is determining whether and when there is sufficient evidence to raise a safety alert. We propose to quantify the expected value of the information (VOI) to be gained through continued monitoring in terms of its potential to reduce health losses among future patients and weigh this against the health cost of exposing current patients during continued monitoring. Objective. To apply this sequential VOI approach to monitoring the comparative safety of prasugrel v. clopidogrel on gastrointestinal (GI) bleeding. Methods. We calculated expected health losses assuming expected mortality, nonfatal myocardial infarction (MI), and nonfatal stroke on clopidogrel were 1.27, 5.93, and 1.14 per 100 person-years, using historical data; relative rates on prasugrel were 0.95, 0.76, and 1.02 based on trial data; and MI, stroke, and GI bleed were 9%, 25%, and 0.1% as bad as death, respectively. We assigned gamma prior distributions to the rates of bleeding on clopidogrel and prasugrel to capture baseline uncertainty; in Monte Carlo simulations, prasugrel’s efficacy parameters were sampled from distributions. Results. Treating all patients with prasugrel minimized expected health losses, resulting in 475.3 death-equivalents over 25,000 person-years of treatment. Monitoring increased expected losses by 5, and treating all patients with clopidogrel increased losses by 46.4. In Monte Carlo simulation, monitoring on average increased expected losses by 4.6, but a reduction in losses from monitoring was supported within the bounds of uncertainty (95% confidence interval, −0.6 to 11.1). Limitations. Patient heterogeneity and the possibility of updating efficacy parameters during monitoring were not incorporated. Conclusion. The proposed approach integrates expected health harms and benefits of continued monitoring in the decision to raise a safety alert.
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Affiliation(s)
- Amanda R. Patrick
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts (ARP, JMF, RJG, SS)
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (MCW)
| | - Jessica M. Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts (ARP, JMF, RJG, SS)
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (MCW)
| | - Milton C. Weinstein
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts (ARP, JMF, RJG, SS)
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (MCW)
| | - Robert J. Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts (ARP, JMF, RJG, SS)
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (MCW)
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts (ARP, JMF, RJG, SS)
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (MCW)
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Rumsfeld JS, Alexander KP, Goff DC, Graham MM, Ho PM, Masoudi FA, Moser DK, Roger VL, Slaughter MS, Smolderen KG, Spertus JA, Sullivan MD, Treat-Jacobson D, Zerwic JJ. Cardiovascular health: the importance of measuring patient-reported health status: a scientific statement from the American Heart Association. Circulation 2013; 127:2233-49. [PMID: 23648778 DOI: 10.1161/cir.0b013e3182949a2e] [Citation(s) in RCA: 403] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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