Characteristics and prognosis of acute myocardial infarction by discharge diagnosis: the Reasons for Geographic and Racial Differences in Stroke study

Implications of Under-Reporting Medication Side Effects: Beta-Blockers in Heart Failure as a Case Example

INTRODUCTION

Perceiving medication side effects but not reporting them to a clinician is common. Patterns of "under-reporting" and their implications are not well described. We aimed to address this gap by examining patterns of under-reporting perceived side effects of beta-blockers among patients with heart failure.

METHODS

In 2016, a survey that evaluated medication-taking behavior was administered to 1114 participants (46.5% response rate) from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort with prior adjudicated heart failure hospitalization or a heart failure Medicare claim. We examined the results of survey respondents who reported taking a beta-blocker to understand patterns of under-reporting perceived beta-blocker side effects. We defined an under-reporter as a participant who perceived experiencing a side effect from their beta-blocker but did not share it with their clinician (according to survey responses). We conducted a multivariable logistic regression analysis to identify determinants of being an under-reporter. Co-variates included age, sex, race, income, level of education, geographical location, and pill burden. We also examined whether under-reporters differed in self-reported medication adherence and willingness to take additional medication to prevent a future healthcare encounter compared to participants who reported perceived side effects to their clinicians and those who did not experience side effects.

RESULTS

Among 310 respondents, 28% (n = 87) were under-reporters. Black race (odds ratio 2.11, confidence interval 1.21-3.67) and education less than college (odds ratio 2.00, confidence interval 1.09-3.67) were associated with being an under-reporter. Self-reported medication adherence was similar between groups (under-reporters: 46.3%; those who reported perceived side effects: 49.4%; those who did not experience side effects: 45.0%); under-reporters were more frequently unwilling to take additional medication to prevent a doctor's visit (18.9% vs 12.1% vs 10.8%), emergency room visit (21.6% vs 13.3% vs 9.9%), and hospitalization (17.6% vs 10.8% vs 9.0%) compared with the other groups.

CONCLUSION

We conclude that under-reporting perceived side effects of beta-blockers among adults with heart failure is common, is associated with Black race and low education, and may contribute to patient willingness to take additional medication to prevent future medical encounters.

A Minimally Invasive Exosome Spray Repairs Heart after Myocardial Infarction

Myocardial infarction (MI) remains the most common cause of death worldwide. Many MI survivors will suffer from recurrent heart failure (HF), which has been recognized as a determinant of adverse prognosis. Despite the success of improved early survival after MI by primary percutaneous coronary intervention, HF after MI is becoming the major driver of late morbidity, mortality, and healthcare costs. The development of regenerative medicine has brought hope to MI treatment in the past decade. Mesenchymal stem cell (MSC)-derived exosomes have been established as an essential part of stem cell paracrine factors for heart regeneration. However, its regenerative power is hampered by low delivery efficiency to the heart. We designed, fabricated, and tested a minimally invasive exosome spray (EXOS) based on MSC exosomes and biomaterials. In a mouse model of acute myocardial infarction, EXOS improved cardiac function and reduced fibrosis, and promoted endogenous angiomyogenesis in the post-injury heart. We further tested the feasibility and safety of EXOS in a pig model. Our results indicate that EXOS is a promising strategy to deliver therapeutic exosomes for heart repair.

Incidence of myocardial infarction and associated mortality varies by latitude and season: findings from a Swedish Registry Study

BACKGROUND

We investigated whether the incidence of death following myocardial infarction (MI) varied by season and latitude in the Swedish population.

METHODS

We studied deaths following MI from January 1987 to December 2009, using the Swedish National Cause of Death Register. County of residence was used to determine latitude and population density. An extension of Poisson regression was used to study the relationship between risk of death following MI with age, latitude, time (from 1987), population density and calendar days.

RESULTS

Over the study period, there was a secular decrease in the incidence of MI-related death. In men, MI-related death incidence increased by 1.3% [95% confidence interval (CI) = 1.1-1.5] per degree of latitude (northwards). In women, MI-related death incidence increased by 0.6% (95% CI = 0.4-0.9) per degree of latitude. There was seasonal variation in the risk of MI-related death with peak values in the late winter and a nadir in the summer months in both the north and the south of Sweden. Findings were similar with incident MI as the outcome.

CONCLUSIONS

The incidence of MI-related death varied markedly by season and latitude in Sweden, with summer months and more southerly latitude associated with lower rates than winter months and more northerly latitude.

Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals.

RESULTS

Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

The risk of arterial thromboembolic events after cancer diagnosis

BACKGROUND

Retrospective studies have reported an association between cancer and arterial thromboembolic event (ATE) risk.

OBJECTIVES

We sought to confirm this in a prospective cohort with adjudicated outcomes.

METHODS

We evaluated participants enrolled in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study with Medicare coverage for 365 days before their baseline visit (2003-2007). Medicare claims were used to identify new cancer diagnoses during follow-up. Using incidence-density sampling, participants who developed cancer were matched by age, sex, race, and education 1:4 to control participants who had not developed cancer. Participants were prospectively followed through 2015 for an expert-adjudicated ATE, defined as acute myocardial infarction or ischemic stroke. Cox regression was performed to evaluate the association between incident cancer and subsequent ATE.

RESULTS

In this analysis, 836 REGARDS participants with incident cancer were matched to 3339 control participants without cancer. In the 30 days after cancer diagnosis, 0.60% (n = 5) of the participants had an ATE; most of these events occurred near the time of cancer diagnosis. After adjustment for demographics, geographic region, and cardiovascular risk factors, compared to the noncancer controls, participants with incident cancer had an increased risk of ATE in the first 30 days after diagnosis (hazard ratio, 5.8; 95% confidence interval, 2.1-15.9). There was no association between cancer diagnosis and ATE beyond 30 days. Cancers with known metastases and types considered high risk for venous thromboembolism had the strongest associations with ATE.

CONCLUSIONS

Incident cancer is associated with an increased short-term risk of ATE independent of vascular risk factors.

Comparative study on short-term and long-term prognostic determinants in patients with acute cerebral infarction

BACKGROUND

At present, there are many studies on prognostic determinants in patients with acute cerebral infarction, while studies on short-term and long-term prognostic determinants are less. The purpose of this study was to explore the short-term and long-term association and same and different points of prognostic determinants in patients with acute cerebral infarction for guiding clinical treatment.

METHODS

201 patients with acute cerebral infarction were included in the study, whose neurological functions were assessed via National Institute of Health Stroke Scale (NIHSS) within 24 h and computed tomography or magnetic resonance imaging were performed within 48 h of symptom onset. All of the patients were administered with same medication regimen (including medication and rehabilitation). The NIHSS and the modified Rankin Scale were used to assess the extent of disability at 15 d after admission and one year, respectively. Short-term and long-term prognostic determinants and its association were analyzed by single and multivariable logistic regression.

RESULTS

Infarct volume correlated with short-term prognosis (OR = 3.543, 95% CI: 1.632~10.212), while it showed no correlation with long-term prognosis; concurrent infection was independent risk factor for short-term prognosis of acute cerebral infarction (OR = 2.532, 95% CI: 1.803~6.886). Baseline NIHSS score independently correlated with short-term and long-term prognosis (odds ratio, respectively: OR = 1.880, 95% CI: 1.462~6.679; OR = 1.761, 95% CI: 1.372~6.758); gender (OR = 0.311, 95% CI: 0.140~0.681) and basal ganglia infarction (OR = 2.263, 95% CI: 1.349~11.662) were independently associated with long-term prognosis, while it showed no significant correlation with short-term prognosis. Short-term prognosis effect was an independent predictor for long-term prognosis (OR = 0.487, 95% CI: 0.141~0.895). Age, hospitalization time, short-term and long-term prognosis of patients showed no significant correlation.

CONCLUSION

There were differences between short-term and long-term prognosis of acute cerebral infarction. Short-term prognosis effect was an independent predictor for long-term prognosis. For controllable factors, active intervene should be taken in order to improve prognosis of patients.