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Zeldetz V, Shashar S, Cafri C, Shamia D, Slutsky T, Abu Abed N, Schwarzfuchs D. STEMI in Times of Crisis: Comparative Analysis During Pandemic and War. J Clin Med 2025; 14:1720. [PMID: 40095790 PMCID: PMC11900518 DOI: 10.3390/jcm14051720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 02/18/2025] [Accepted: 03/01/2025] [Indexed: 03/19/2025] Open
Abstract
Background: Crises such as pandemics and wars significantly impact cardiovascular health, particularly ST-Elevation Myocardial Infarction (STEMI). The COVID-19 pandemic led to overwhelmed healthcare systems and delayed care, while the October 2023 war in Israel posed unique challenges, including altered patient behavior and access to care. This study compares STEMI outcomes during these two crisis periods, focusing on mortality and care pathways. Methods: This retrospective cohort study, conducted at Soroka University Medical Center, analyzed patients with STEMI during the COVID-19 lockdown (14 March 2020-14 June 2020), the war period (07 October 2023-7 January 2024), and quiet periods in 2022. Patient demographics, arrival methods, and outcomes were compared. Multivariable logistic regression identified mortality predictors. Results: Among 397 patients with STEMI, 30-day mortality was 7.5 times higher during COVID-19 (OR 7.50, p = 0.038), and in-hospital mortality was 10.25 times higher (OR 10.25, p = 0.046) compared to the war. The war period showed an 86% reduction in 30-day mortality (OR 0.14, p = 0.026). More patients arrived by ambulance during COVID-19, while during the war, more were referred via emergency medical centers and admitted directly to the ICCU. Conclusions: The COVID-19 pandemic significantly increased STEMI mortality, while the war's coordinated care pathways improved outcomes. Tailored crisis management strategies are important to ensure effective acute care during pandemics and conflicts.
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Affiliation(s)
- Vladimir Zeldetz
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva 84101, Israel; (V.Z.); (T.S.); (N.A.A.); (D.S.)
| | - Sagi Shashar
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Carlos Cafri
- Department of Cardiology, Soroka University Medical Centre, Beer Sheva 84101, Israel; (C.C.); (D.S.)
| | - David Shamia
- Department of Cardiology, Soroka University Medical Centre, Beer Sheva 84101, Israel; (C.C.); (D.S.)
| | - Tzachi Slutsky
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva 84101, Israel; (V.Z.); (T.S.); (N.A.A.); (D.S.)
- Hospital Administration, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Naif Abu Abed
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva 84101, Israel; (V.Z.); (T.S.); (N.A.A.); (D.S.)
| | - Dan Schwarzfuchs
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva 84101, Israel; (V.Z.); (T.S.); (N.A.A.); (D.S.)
- Hospital Administration, Soroka University Medical Center, Beer Sheva 84101, Israel
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Tzelepis F, Wiggers J, Paul CL, Mitchell A, Byrnes E, Byaruhanga J, Wilson L, Lecathelinais C, Bowman J, Campbell E, Gillham K. A randomised trial of real-time video counselling for smoking cessation among rural and remote residents. J Telemed Telecare 2024:1357633X241273076. [PMID: 39165226 DOI: 10.1177/1357633x241273076] [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: 08/22/2024]
Abstract
INTRODUCTION Despite its reach, very limited evidence exists on the effectiveness of real-time video counselling for smoking cessation (e.g. via Skype). This study compared the effectiveness of real-time video counselling for smoking cessation to (a) telephone counselling; and (b) a control among rural and remote residents. METHODS Between 25 May 2017 and 3 March 2020, a three-arm, parallel group, randomised trial, randomised 1244 rural and remote residents from New South Wales, Australia who smoked tobacco to: video counselling (4-6 video sessions); telephone counselling (4-6 telephone calls); or a control (printed materials). The primary outcome was 7-day point prevalence abstinence at 13 months post-baseline. Secondary outcomes were point prevalence abstinence at 4 months and 7-months post-baseline, prolonged abstinence, quit attempts, anxiety and depression. RESULTS For the primary outcome of 7-day point prevalence abstinence at 13 months post-baseline, there was no significant difference between video counselling and telephone counselling (14.6% vs 13.3%; (OR = 1.11, 95% CI (0.75-1.64), P = 0.61) or video counselling and control (14.6% vs 13.9%; (OR = 1.06, 95% CI (0.71-1.57), P = 0.77). For secondary outcomes at 4 months post-baseline, the video counselling group had significantly higher odds than the control of 7-day point prevalence abstinence (14.3% vs 8.2%; OR = 1.88, 95% CI (1.20-2.95), P = 0.006) and 3-month prolonged abstinence (4.9% vs 2.2%; OR = 2.28, 95% CI (1.03-5.07), P = 0.04). There were no significant differences for other secondary outcomes. DISCUSSION Video counselling increased smoking cessation in the short-term compared to a control although strategies to improve its long-term effectiveness are needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au ACTRN12617000514303.
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Affiliation(s)
- Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Louise Wilson
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Christophe Lecathelinais
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Jennifer Bowman
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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Loutati R, Bruoha S, Taha L, Karmi M, Perel N, Maller T, Amsalem I, Hitter R, Levi N, Zacks N, Shrem M, Amro M, Shuvy M, Glikson M, Asher E. The Effect of War on STEMI Incidence: Insights from Intensive Cardiovascular Care Unit Admissions. J Clin Med 2024; 13:1356. [PMID: 38592151 PMCID: PMC10931653 DOI: 10.3390/jcm13051356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The impact of armed conflicts on public health is undeniable, with psychological stress emerging as a significant risk factor for cardiovascular disease (CVD). Nevertheless, contemporary data regarding the influence of war on CVD, and especially on acute coronary syndrome (ACS), are scarce. Hence, the aim of the current study was to assess the repercussions of war on the admission and prognosis of patients admitted to a tertiary care center intensive cardiovascular care unit (ICCU). (2) Methods: All patients admitted to the ICCU during the first three months of the Israel-Hamas war (2023) were included and compared with all patients admitted during the same period in 2022. The primary outcome was in-hospital mortality. (3) Results: A total of 556 patients (184 females [33.1%]) with a median age of 70 (IQR 59-80) were included. Of them, 295 (53%) were admitted to the ICCU during the first three months of the war. Fewer Arab patients and more patients with ST-segment elevation myocardial infraction (STEMI) were admitted during the war period (21.8% vs. 13.2%, p < 0.001, and 31.9% vs. 24.1%, p = 0.04, respectively), whereas non-STEMI (NSTEMI) patients were admitted more frequently in the pre-war year (19.3% vs. 25.7%, p = 0.09). In-hospital mortality was similar in both groups (4.4% vs. 3.4%, p = 0.71; HR 1.42; 95% CI 0.6-3.32, p = 0.4). (4) Conclusions: During the first three months of the war, fewer Arab patients and more STEMI patients were admitted to the ICCU. Nevertheless, in-hospital mortality was similar in both groups.
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Affiliation(s)
- Ranel Loutati
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, and The Ben-Gurion University of the Negev, Ashkelon 7830604, Israel;
| | - Louay Taha
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Mohammad Karmi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Nimrod Perel
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Tomer Maller
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Rafael Hitter
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Nir Levi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Netanel Zacks
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Maayan Shrem
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Motaz Amro
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Mony Shuvy
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Michael Glikson
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Elad Asher
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
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Redfern J, Gregory AT, Raman J, Figtree GA, Singleton A, Denniss AR, Ferguson C. Environment, Climate and Cardiovascular Health: What We Know, What We Need to Know and What We Need to Do. Heart Lung Circ 2023; 32:1-3. [PMID: 36739116 DOI: 10.1016/j.hlc.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Ann T Gregory
- Heart, Lung and Circulation, Sydney, NSW, Australia. https://twitter.com/HeartLungCirc
| | - Jai Raman
- Austin & St Vincent's Hospitals, Melbourne, and University of Melbourne, Vic, Australia; Deakin University, Geelong & Melbourne, Vic, Australia; James Cook University, Townsville & Cairns, Qld, Australia; University of Illinois, Urbana-Champaign, IL, USA
| | - Gemma A Figtree
- Department of Cardiology, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
| | - Anna Singleton
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - A Robert Denniss
- Heart, Lung and Circulation, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, and University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Blacktown Hospital, and Western Sydney University, Sydney, NSW, Australia
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
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