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Liang L, Shao T, Li H, Zhao M, Tang W. Cost-effectiveness and potential budget impact of non-pharmacological interventions for early management in prehypertensive people: an economic evaluation for China. BMC Public Health 2023; 23:1531. [PMID: 37568086 PMCID: PMC10416408 DOI: 10.1186/s12889-023-16458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Non-pharmacological interventions (NPIs) could be considered in the early management of prehypertensive population. This study aimed to evaluate the potential cost-effectiveness of NPIs and the budget impact of implementing NPIs on prehypertensive population in China and provide evidence of chronic disease management innovation for decision-makers. METHODS Five NPIs including usual care, lifestyle, strengthen exercise, relaxation, and diet therapy were selected based on the practice of hypertension management in China. A nine-state Markov model was constructed to evaluate the lifetime costs and health outcomes of five NPIs and a non-intervention group from the perspective of Chinese healthcare system. The effectiveness of NPIs was obtained from a published study. Parameters including transition probabilities, costs and utilities were extracted or calculated from published literature and open-access databases. Sensitivity analyses were conducted to test the uncertainty of all parameters. The impact of duration of intervention was considered in scenario analyses. A budget impact analysis (BIA) was conducted to evaluate the total cost and the medical cost saving of a hypothetical nationwide implementation of potential cost-effective NPI in prehypertensive people. Management strategies including focusing on patients with specific ages or different CVE risk levels, and different duration of implementation were taken into consideration. RESULTS Strengthen exercise was the most cost-effective intervention with a probability of 78.1% under the given WTP threshold. Our results were sensitive to the cost of interventions, and the utility of prehypertension and hypertension. The duration of implementation had limited impact on the results. BIA results showed that the program cost was hefty and far more than the medical cost saving with the course of simulation time. Applying management strategies which focused on individual characteristics could largely reduce the program cost despite it remained higher than medical cost saving. CONCLUSIONS Strengthen exercise was a potential NPI that can be considered in priority for early management in prehypertensive population. Although early management can acquire medical cost saving, the related program cost can be quite hefty. Precise strategies which may help reduce the cost of early management should be taken into consideration in program design.
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Affiliation(s)
- Leyi Liang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Taihang Shao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Hao Li
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Mingye Zhao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Wenxi Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
- Department of Public Affairs Management, School of International Pharmaceutical Business, Pharmaceutical University, 211198, Nanjing, China.
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Hwang SY, Kim SH, Uhm IA, Shin JH, Lim YH. Prognostic implications for patients after myocardial infarction: an integrative literature review and in-depth interviews with patients and experts. BMC Cardiovasc Disord 2022; 22:348. [PMID: 35918641 PMCID: PMC9344648 DOI: 10.1186/s12872-022-02753-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background As patients with myocardial infarction (MI) survive for a long time after acute treatment, it is necessary to pay attention to the prevention of poor prognosis such as heart failure (HF). To identify the influencing factors of adverse clinical outcomes through a review of prospective cohort studies of post-MI patients, and to draw prognostic implications through in-depth interviews with post-MI patients who progressed to HF and clinical experts. Methods A mixed-method design was used that combined a scoping review of 21 prospective cohort studies, in-depth interviews with Korean post-MI patients with HF, and focus group interviews with cardiologists and nurses. Results A literature review showed that old age, diabetes, high Killip class, low left ventricular ejection fraction, recurrent MI, comorbidity of chronic disease and current smoking, and low socioeconomic status were identified as influencing factors of poor prognosis. Through interviews with post-MI patients, these influencing factors identified in the literature as well as a lack of disease awareness and lack of self-care were confirmed. Experts emphasized the importance of maintaining a healthy lifestyle after acute treatment with the recognition that it is a chronic disease that must go together for a lifetime. Conclusion This study confirmed the factors influencing poor prognosis after MI and the educational needs of post-MI patients with transition to HF. Healthcare providers should continue to monitor the risk group, which is expected to have a poor prognosis, along with education emphasizing the importance of self-care such as medication and lifestyle modification.
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Affiliation(s)
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, 222-1 Wangsimniro, Seondong-gu, Seoul, 04763, South Korea.
| | - In Ae Uhm
- School of Nursing, Hanyang University, Seoul, South Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Gyeonggi-do, South Korea
| | - Young-Hyo Lim
- Division of Cardiology Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea.
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Jabali MS, Sadeghi M, Nabovati E, Sarrafzadegan N, Farzandipour M. Determination of Characteristics and Data Elements requirements in National Acute Coronary Syndrome Registries for Post-discharge Follow-up. Curr Probl Cardiol 2022:101244. [DOI: 10.1016/j.cpcardiol.2022.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/03/2022]
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Chen CW, Lin YC, Shih CM, Chen WT, Lin FY, Bi WF, Kao YT, Chiang KH, Chan CS, Hsu CY, Yang TL, Hsiao CY, Hsiao BY, Chien LN, Huang CY. Association of multiple preventive therapies postdischarge and long-term health outcomes after acute myocardial infarction. J Chin Med Assoc 2021; 84:1084-1091. [PMID: 34561408 DOI: 10.1097/jcma.0000000000000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guidelines as secondary prevention medications to improve the long-term outcomes of post-acute myocardial infarction (AMI) patients. However, adequate drug adherence has always been challenging, and different treatment regimens may lead to divergent outcomes that remain unclear under current myocardial infarction (MI) care standards. This study investigated the association between use of different preventive regimens post-AMI and patients' long-term outcomes. METHODS This cohort study used data files from the Taiwan National Health Insurance Research Database. A total of 77 520 people who were hospitalized with AMI between 2002 and 2015 were assessed. On the basis of medication possession ratio (MPR) to individual medications, eight treatment groups were examined in this study. Receiving therapy was defined as MPR ≥40%. We investigated the association between different treatment groups and all-cause mortality in 24 months. RESULTS Overall, 51 322 patients with ST-elevation MI and 26 198 with non-ST-elevation MI were included in the study. Patients received all three preventive medications show the lowest mortality in 24 months follow-up periods among all treatment groups. Patients who did not usage of any of these three preventive medications had the highest mortality in 24 months (adjusted hazard ratio, 1.78; 95% CI, 1.64-1.93). This mortality rate had the same pattern across the three cohort generations (2002-2005, 2006-2010, and 2011-2015). CONCLUSION In this large population-based real-world study, usage of three preventive therapies post-MI was associated with the lowest rate of all-cause mortality.
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Affiliation(s)
- Chih-Wei Chen
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yi-Cheng Lin
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chun-Ming Shih
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wan-Ting Chen
- Office of Data Center, Taipei Medical University, Taipei, Taiwan, ROC
| | - Feng-Yen Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wei-Fung Bi
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yung-Ta Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Kuang-Hsing Chiang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chao-Shun Chan
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chien-Yi Hsu
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Tsung-Lin Yang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Cheng-Yi Hsiao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Bu-Yuan Hsiao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Li-Nien Chien
- Office of Data Center, Taipei Medical University, Taipei, Taiwan, ROC
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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Romagnoli A, Santoleri F, Costantini A. Adherence and persistence analysis in patients treated with double antiplatelet therapy (DAPT) at two years in real life. PATIENT EDUCATION AND COUNSELING 2021; 104:2012-2017. [PMID: 33461875 DOI: 10.1016/j.pec.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Double antiplatelet therapy (DAPT) is indicated for the treatment of coronary artery diseases (CAD). The optimal duration of therapy with DAPT continues to be a subject of debate in the scientific community. To improve adherence to DAPT, the FDC (fixed dose combination) of Acetylsalicylic acid (ASA) and clopidogrel was developed into a single pill instead of two separate pills thus facilitating the dosage and administration of the therapy and increasing compliance. The aim of this study was to assess adherence and persistence over a period of two years in patients treated with DAPT composed of: ASA/clopidogrel, ASA/prasugrel, ASA/ticagrelor and FDC with ASA and clopidogrel in real life and to assess whether the use of ASA and clopidogrel FDC is associated with improved adherence. MATERIALS AND METHODS In the following retrospective pharmacological-observational non-interventional study, all patients treated with DAPT in the Hospital of Pescara from January 2010 to October 2019 were considered. Persistence to treatment is defined as the duration of time from initiation to discontinuation of treatment. Adherence was calculated as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD). RESULTS 277 patients treated with ASA/clopidogrel, 77 patients treated with ASA/prasugrel, 57 patients treated with ASA/ticagrelor and 108 patients treated with FDC of ASA/clopidogrel were analysed. Persistence curves at two years showed a statistically significant difference (p < 0.001). Adherence to therapy was optimal with an absolute value at two years of 0.96. Adherence was better in patients treated with ASA/prasugrel with a value of 0.98 and with 97 % of patients with an adherence value greater than or equal to 0.8, while, it was worse in patients treated with FDC ASA/clopidogrel with an absolute value of 0.94 and with 88 % of patients with an optimal adherence value. No statistically significant difference was found between the ASA/clopidogrel FDC in comparison to each component taken as a separate pill (p = 0.0752). CONCLUSION DAPT along with ASA/clopidogrel showed a statistically significant better persistence than ASA/ticagrelor and ASA/prasugrel. Whereas, to our knowledge and as per the current literature no statistically significant differences were found, in terms of adherence in real life, between the use of ASA/Clopidogrel FDC and the use of two different pills.
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Affiliation(s)
- Alessia Romagnoli
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
| | - Fiorenzo Santoleri
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
| | - Alberto Costantini
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
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Lee CK, Wang TD, Juang HT, Chang SC, Pan HY, Lin DSH, Chang CJ. Efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction in Taiwan. Sci Rep 2021; 11:14150. [PMID: 34239030 PMCID: PMC8266799 DOI: 10.1038/s41598-021-93712-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/29/2021] [Indexed: 01/31/2023] Open
Abstract
The clinical efficacy of ticagrelor versus clopidogrel has not been replicated in East Asian populations. The pronounced bleeding risk with ticagrelor was of concern given the increased bleeding tendency in Asian populations. This study evaluated efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction (NSTEMI) in the entire Taiwan. We used the Taiwan National Health Insurance Research Database to identify 6203 patients aged ≥ 20 years with NSTEMI hospitalization and prescription of dual antiplatelets at discharge between January 2014 and December 2014. Cohorts of ticagrelor and clopidogrel were matched 1:1 based on propensity score matching to balance baseline covariates. The primary composite efficacy endpoints included death from any cause, non-fatal myocardial infarction, and non-fatal stroke. The secondary efficacy endpoints were the individual components. The primary safety endpoint was major bleeding requiring hospitalization. The incidence of primary efficacy endpoint was 20.3% in the ticagrelor users and 20.7% in the clopidogrel users (adjusted HR 0.94; 95% CI 0.73–1.22), with the median (interquartile range, IQR) follow-up period of 5.2 (2.3–8.5) months. The incidence of primary safety endpoint was 2.3% in the ticagrelor users and 3.2% in the clopidogrel users (adjusted HR 0.67; 95% CI 0.33–1.35). Regarding the secondary efficacy endpoint, patients treated with ticagrelor had significantly lower incidence of stroke (adjusted HR 0.44; 95% CI 0.21–0.94; p = 0.033). In this nationwide Taiwanese cohort of NSTEMI, treatment with ticagrelor after discharge, as compared to clopidogrel, had similar rates of ischemic composite events and major bleeding. Nevertheless, the median follow-up time was only 5.2 months, and the reduced stroke events with ticagrelor compared to clopidogrel needs further verification.
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Affiliation(s)
- Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Dau Wang
- College of Medicine, National Taiwan University, Taipei, Taiwan. .,Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhong-Shan South Road, Taipei City, 10002, Taiwan.
| | - Hsiao-Ting Juang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyüan, Taiwan
| | - Shu-Chen Chang
- Research Services Center for Health Information, Chang Gung University, Taoyüan, Taiwan
| | - Heng-Yu Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Donna Shu-Han Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhong-Shan South Road, Taipei City, 10002, Taiwan
| | - Chee-Jen Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyüan, Taiwan. .,Research Services Center for Health Information, Chang Gung University, Taoyüan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyüan, Taiwan. .,Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Biomedical Sciences, Chang Gung University, Taoyüan, Taiwan.
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Usefulness of Estimated Pulse Wave Velocity in Prediction of Cardiovascular Mortality in Patients With Acute Myocardial Infarction. Am J Med Sci 2021; 361:479-484. [PMID: 33637306 DOI: 10.1016/j.amjms.2020.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/07/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pulse wave velocity (PWV) is an excellent index of arterial stiffness and can be used to predict long-term cardiovascular (CV) outcome. In recent years, estimated PWV (ePWV), calculated by equations using age and mean blood pressure, was also reported to be a significant predictor of CV outcomes. However, there was no literature discussing about usefulness of ePWV in patients of acute myocardial infarction (AMI) for prediction of long-term CV and overall mortality. Therefore, we conducted this study for further evaluation. METHODS A total of 187 patients with AMI admitted to cardiac care unit were enrolled. ePWV were calculated by the equations for each patient. RESULTS The median follow-up to mortality was 73 months (25th-75th percentile: 8-174 months). There were 35 and 125 patients documented as CV and overall mortality, respectively. Under univariable analysis, ePWV could independently predict long-term CV and overall mortality. However, after multivariable analysis, ePWV could only predict long-term CV mortality in AMI patients. CONCLUSIONS To the best of our knowledge, our study was the first to evaluate the usefulness of ePWV in AMI patients for prediction of long-term CV and overall mortality. Our study showed ePWV was not only easy to calculate by formula, but also an independent predictor for long-term CV mortality in univariable and multivariable analyses. Therefore, ePWV was a simple and useful tool to measure arterial stiffness and to predict CV mortality outcome in AMI patients without the necessity for equipment to measure PWV.
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Xu Q, Yang N, Feng S, Guo J, Liu QB, Hu M. Cost-effectiveness analysis of combining traditional Chinese medicine in the treatment of hypertension: compound Apocynum tablets combined with Nifedipine sustained-release tablets vs Nifedipine sustained-release tablets alone. BMC Complement Med Ther 2020; 20:330. [PMID: 33153455 PMCID: PMC7643403 DOI: 10.1186/s12906-020-03091-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 09/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background We evaluated the long-term cost-effectiveness of antihypertensive traditional Chinese medicines (TCMs) and to compare the cost-effectiveness of a combined treatment consisting of compound Apocynum tablets and Nifedipine sustained-release tablets with the cost-effectiveness of treatment with Nifedipine sustained-release tablets alone. Methods A Markov model was used to simulate the potential incremental cost-effectiveness per quality-adjusted life year (QALY) to be gained from compound Apocynum tablets and Nifedipine sustained-release tablets compared with Nifedipine sustained-release tablets alone. Model parameter estimates were informed by previously published studies. The direct medical costs of outpatients with hypertension were estimated from the health care provider’s perspective. A 5% annual discount rate was applied to both costs and QALYs. Results TCMs combined with Nifedipine sustained-release tablets group generated a total 20-year cost of 11,517.94 RMB (US $1739.87), whereas Nifedipine sustained-release tablets alone group resulted in a 20-year cost of 7253.71 RMB (US $1095.73). TCMs combined with Nifedipine sustained-release tablets group resulted in a generation of 12.69 QALYs, whereas Nifedipine sustained-release tablets alone group resulted in 12.50. The incremental cost-utility ratio was 22,443.32 RMB (US $3390.23) per QALY. Considering the threshold of 1 GDP per capita in China in 2018 (US $9764.95), the combination of compound Apocynum tablets and Nifedipine sustained-release tablets was a cost-effective strategy. One-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range. Conclusions Combining Traditional Chinese Medicines with chemical medicines is more cost-effective strategy in the treatment of hypertension.
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Affiliation(s)
- Qian Xu
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China
| | - Nan Yang
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China
| | - Shuang Feng
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China
| | - Jianfei Guo
- Division of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Qi-Bing Liu
- Department of Pharmacology, School of Pharmaceutical Science, Hainan Medical University, Haikou, Hainan, China.
| | - Ming Hu
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China.
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Li YH, Lee CH, Huang WC, Wang YC, Su CH, Sung PH, Chien SC, Hwang JJ. 2020 Focused Update of the 2012 Guidelines of the Taiwan Society of Cardiology for the Management of ST-Segment Elevation Myocardial Infarction. ACTA CARDIOLOGICA SINICA 2020; 36:285-307. [PMID: 32675921 PMCID: PMC7355116 DOI: 10.6515/acs.202007_36(4).20200619a] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
One of the major missions of the Taiwan Society of Cardiology is to publish practice guidelines that are suitable for local use in Taiwan. The ultimate purpose is to continuously improve cardiovascular health care from the implementation of the recommendations in the guidelines. Despite recent improvement of medical care, patients with ST-segment elevation myocardial infarction (STEMI) still carry a high morbidity and mortality. There have been many changes in the concepts of STEMI diagnosis and treatment in recent years. The 2020 focused update of the 2012 guidelines of the Taiwan Society of Cardiology for the management of STEMI is an amendment of the 2012 guidelines based on the newest published scientific data. The recommendations in this focused update provide the diagnosis and treatment strategy for STEMI that should be generally implemented in Taiwan. Nevertheless, guidelines never completely replace clinical judgment and medical decision still should be determined individually.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Cheng-Han Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang Ming University, Taipei
- Department of Physical Therapy, Fooyin University, Kaohsiung
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital
- Department of Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
| | - Pei-Hsun Sung
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine
| | - Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Ando T, Nakazato K, Kimishima Y, Kiko T, Shimizu T, Misaka T, Yamada S, Kaneshiro T, Yoshihisa A, Yamaki T, Kunii H, Takeishi Y. The clinical value of the PRECISE-DAPT score in predicting long-term prognosis in patients with acute myocardial infarction. IJC HEART & VASCULATURE 2020; 29:100552. [PMID: 32551359 PMCID: PMC7287192 DOI: 10.1016/j.ijcha.2020.100552] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/28/2022]
Abstract
Background The predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score predicts the risk of bleeding in patients treated with dual antiplatelet therapy after percutaneous coronary intervention. Although the PRECISE-DAPT score is expected to be useful beyond its original field, long-term prognostic value of this score in patients with acute myocardial infarction (AMI) remains unclear. In the current study, we aimed to investigate the performance of the PRECISE-DAPT score in predicting the long-term prognosis in patients with AMI. Methods and results Consecutive 552 patients with AMI, who had been discharged from our institution, were enrolled. We divided the patients into three groups, based on their PRECISE-DAPT scores: the low (PRECISE-DAPT < 17), intermediate (17–24) and high (≥25) score groups. Kaplan-Meier analysis (mean follow-up 1424 days) revealed that all-cause mortality increased most steeply in the high score group followed by the intermediate and low score groups (P < 0.001). After adjusting for possible confounding factors, mortality of the intermediate or high score groups were higher than those of low score group (HR 2.945, 95% CI 1.182–7.237, P = 0.020, and HR 5.567, 95% CI 2.644–11.721, P < 0.001, respectively). Conclusions In patients with AMI, a high PRECISE-DAPT score was associated with higher long-term all-cause mortality. PRECISE-DAPT score is useful for predicting all-cause mortality, as well as risk stratification of bleeding.
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Affiliation(s)
| | - Kazuhiko Nakazato
- Corresponding author at: Department of Cardiovascular Medicine, Fukushima Medical University. 1 Hikarigaoka, Fukushima 960-1295, Japan.
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Lin CC, Lee PY, Chen KC, Liao PC, Hsu JC, Li AH. Clinical, Demographic, and Biochemical Characteristics of Patients with Acute ST-Segment Elevation Myocardial Infarction: An Analysis of Acute Coronary Syndrome Registry Data of a Single Medical Center from 2005 to 2016. ACTA CARDIOLOGICA SINICA 2020; 36:1-7. [PMID: 31903002 DOI: 10.6515/acs.202001_36(1).20190704d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background ST-segment elevation myocardial infarction (STEMI) is one of the leading causes of morbidity and mortality in developed countries. Therefore, understanding the prevalence and trends of major risk factors may facilitate primary and secondary prevention of STEMI. Methods In the present study, 2446 consecutive patients with STEMI admitted to Far Eastern Memorial Hospital from 2005 to 2016 were enrolled. A comprehensive analysis of the prevalence, distribution, and trends over time of major risk factors as well as Framingham risk scores of all patients was performed. Results The most prevalent risk factors were male sex, hypertension (HTN), smoking, age, dyslipidemia, and diabetes mellitus. Furthermore, 95%-97% of the patients had at least one modifiable risk factor, and < 1% of the patients did not have any identifiable risk factors. The prevalence trends of smoking, HTN, dyslipidemia, and metabolic syndrome increased significantly from 2005 to 2016. Seasonal variation analysis revealed a 15% increase in STEMI cases between January and March compared with those between April and December. Isolated low high- density lipoprotein-cholesterol syndrome was the second most common type of dyslipidemia, with a prevalence rate of 16.6%. Moreover, only 56.8% of the male and 32% of the female patients were in the Framingham high-risk group. Conclusions A high prevalence rate and an increasing trend of modifiable risk factors resulted in a high number of STEMI cases at our hospital. Controlling modifiable risk factors and improving nontraditional risk factor detection could facilitate primary and secondary preventions for STEMI.
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Affiliation(s)
- Chun-Chung Lin
- Division of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Yu Lee
- Division of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Chin Chen
- Division of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pen-Chih Liao
- Division of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Division of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ai-Hsien Li
- Division of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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12
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Xu H, Zou J, Ye X, Han J, Gao L, Luo S, Wang J, Huang C, Yan X, Dai H. Impacts of Clinical Pharmacist Intervention on the Secondary Prevention of Coronary Heart Disease: A Randomized Controlled Clinical Study. Front Pharmacol 2019; 10:1112. [PMID: 31649528 PMCID: PMC6791923 DOI: 10.3389/fphar.2019.01112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/30/2019] [Indexed: 12/19/2022] Open
Abstract
Coronary heart disease (CHD) is one of the leading causes of morbidity and mortality worldwide, and more efforts should be made to reduce the risk of cardiovascular events. This study aimed to investigate the impact of clinical pharmacist intervention on the prognosis of acute coronary syndrome (ACS) in Chinese patients with CHD. Two hundred and forty patients who had ACS were recruited. Participants were randomly assigned to the intervention group (n = 120) or the control group (n = 120). The intervention group received a medication assessment and education by the clinical pharmacist at discharge and telephone follow-ups at 1 week and 1 and 3 months after discharge. The control group received usual care. The primary outcomes of this study were the proportion of patients who had major adverse cardiovascular events (MACEs), including mortality, nonfatal myocardial infarction (MI), stroke, and unplanned cardiac-related rehospitalizations within 6 and 12 months after hospital discharge. Secondary outcome was self-reported medication adherence to evidence-based medications for CHD (antiplatelets, statins, β-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Of 240 enrolled patients, 238 (98.3%) completed 6-month follow-up, and 235 (97.9%) completed 12-month follow-up. There were no significant differences between intervention and control groups in the percentages of patients who incurred MACEs within the 6-month follow-up (3.3% vs 7.6%, respectively, P = 0.145) or 12-month follow-up (10.9% vs 12.1%, respectively, P = 0.783). Significant improvements were found in the prescribing rates of β-blockers and all four classes of medications at discharge in the intervention group compared with the control group (P = 0.001 and P = 0.009, respectively). There was no significant difference between the intervention and control groups in the use of all four classes of medications at the 6-month follow-up (48.3% vs 45.8%, respectively, P = 0.691) and 12-month follow-up (47.9% vs 46.6%, respectively, P = 0.836). The use of β-blockers was nonsignificantly higher in the intervention group than in the control group at the 6-month follow-up (74.2% vs. 64.4%, P = 0.103) and 12-month follow-up (74.8% vs 63.8%, P = 0.068). Clinical pharmacist intervention had no significant effects on reduction in cardiovascular events among patients with CHD. Further studies with larger sample sizes and longer time frames for both intervention and follow-up are needed to validate the role of the clinical pharmacist in the morbidity and mortality of CHD. Clinical Trial Registration:chictr.org.cn, identifier ChiCTR-IOR-16007716.
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Affiliation(s)
- Huimin Xu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Zou
- Department of Pharmacy, the 117th Hospital of PLA, Hangzhou, Chin
| | - Xiaoli Ye
- Department of Pharmacy, Hangzhou First People's Hospital, Hangzhou, China
| | - Jiayun Han
- Department of Pharmacy, Zhejiang Haining People's Hospital, Jiaxing, China
| | - Lan Gao
- Department of Pharmacy, Ganzhou District Zhangye People's Hospital, Zhangye, China
| | - Shunbin Luo
- Department of Pharmacy, Lishui City People's Hospital, Lishui, China
| | - Jingling Wang
- Department of Pharmacy, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Chunyan Huang
- Department of Pharmacy, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofeng Yan
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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The Taiwan Heart Registries: Its Influence on Cardiovascular Patient Care. J Am Coll Cardiol 2019; 71:1273-1283. [PMID: 29544612 DOI: 10.1016/j.jacc.2018.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
Taiwanese heart registries for the main cardiovascular diseases have been conducted in the past 10 years, with the goal of examining the quality of cardiovascular patient care, which cannot be guaranteed by the universal Taiwan National Health Insurance. The results show suboptimal adherence to guideline recommendations. Door-to-balloon time and dual antiplatelet therapy use in acute coronary syndrome, standard medications for management of heart failure, low-density lipoprotein cholesterol levels in dyslipidemia, anticoagulant agent use in atrial fibrillation, and the understanding of sudden arrhythmia death syndrome were all found to be inadequate. However, all were improved, either by changing National Health Insurance policy or through continuous education for physicians and patients. Thus, specific cardiovascular disease registries could help examine the status of real-world practice, find inadequacies in guideline implementation and understanding of rare diseases, facilitate lobbying to policy makers and education for physicians and patients, and influence and improve cardiovascular patient care.
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Low-density lipoprotein cholesterol target achievement in patients surviving an acute coronary syndrome in Hong Kong and Taiwan - findings from the Dyslipidemia International Study II. Int J Cardiol 2019; 265:1-5. [PMID: 29885676 DOI: 10.1016/j.ijcard.2018.01.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Individuals are at increased risk for cardiovascular events following an acute coronary syndrome (ACS). Effective management of hyperlipidemia, an associated risk factor, is essential for improving outcomes. We aimed to quantify the extent of hyperlipidemia and its treatment in ACS survivors in Hong Kong and Taiwan. METHODS The multinational, observational Dyslipidemia International Study (DYSIS) II included patients hospitalized for an ACS. Lipid levels and use of lipid-lowering therapy (LLT) were evaluated at baseline and 4 months post-discharge. The proportions of patients attaining the recommended LDL-C target for individuals at very high cardiovascular risk (<70 mg/dL) was assessed and potential predictors of this outcome evaluated. RESULTS In total, 270 patients were enrolled, 125 (46.3%) of which were being treated with LLT prior to hospitalization. Of these, 28.8% had an LDL-C level < 70 mg/dL, compared to only 6.9% of those not being treated. Statin monotherapy was the most commonly employed LLT, with a mean atorvastatin-equivalent dosage of 14 mg/day. By 4-month follow-up, target attainment had risen to 45.1% for patients treated with LLT at baseline, and 43.3% for those who had not been treated. LLT was being used by 88.4% of patients at follow-up, with a mean atorvastatin dosage of 18 mg/day. Use of statins in combination with ezetimibe/other non-statin was scarce. No predictors of LDL-C target attainment were identified. CONCLUSIONS In patients hospitalized with an ACS, rates of LDL-C target achievement were poor. While LLT was widely employed, statin intensity was low and combination therapy underused, indicating scope for improvement.
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Liu X, He X, Wu J, Luo D. Initiation And Persistence With Antiplatelet Agents Among The Patients With Acute Coronary Syndromes: A Retrospective, Observational Database Study In China. Patient Prefer Adherence 2019; 13:2159-2169. [PMID: 31908423 PMCID: PMC6925556 DOI: 10.2147/ppa.s228065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate the initiation and persistence of antiplatelet agents and the associated factors for patients with acute coronary syndromes (ACS) in Tianjin, China. METHODS Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011-2015). Adult patients who were discharged alive after the first ACS-related hospitalization (index hospitalization) between January 2012 and December 2014 were included. Patients who initiated with antiplatelet therapy, including aspirin monotherapy, clopidogrel monotherapy, or dual antiplatelet with aspirin and clopidogrel at discharge or within the initial 30-day follow-up after discharge were further identified. Patients with no gaps of ≥30 days in antiplatelet therapy were deemed persistent. The logistic model and Cox model were used to explore the associated factors of initiation and persistence with antiplatelet agents, respectively. RESULTS In total, 21,450 patients (64.6±10.7 years; 46.0% female) were included. Only 70.3% (N=15,071) of them initiated with antiplatelet agents within the initial 30-day follow-up; 85.0% (N=12,809) of the initial users discontinued their antiplatelet therapy, and the average time to discontinuation was 117.4±119.7 days. The patients who had prior antiplatelet agents utilization (Odds ratio [95% CI]=1.93 [1.78-2.09]; hazard ratio [95% CI]=0.78 [0.74-0.81]), received percutaneous coronary intervention (PCI) during the baseline period (OR=1.47 [1.26-1.73]; HR=0.91 [0.84-0.97]) or index hospitalization (OR=22.40 [18.63-26.92]; HR=0.51 [0.49-0.53]) were more likely to initiate and persist with antiplatelet agents, while the female (OR=0.75 [0.70-0.81]; HR=1.22 [1.88-1.27]) patients were less likely to initiate and persist with antiplatelet agents. CONCLUSION The initiation and persistence with antiplatelet agents are poor among the ACS patients in Tianjin. Females are associated with poorer initiation and persistence, while prior antiplatelet agents use and receiving PCI during baseline period or index hospitalization are associated with better initial use and better persistence.
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Affiliation(s)
- Xin Liu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China
- Correspondence: Jing Wu School of Pharmaceutical Science and Technology, Tianjin University, 92 Weijin Road, Nankai District, Tianjin300072, People’s Republic of ChinaTel +862227405176Fax +862287401830 Email
| | - Da Luo
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China
- Tianjin Health Development Research Center, Tianjin, People’s Republic of China
- Da Luo School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China Email
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Yeh JJ, Lin CL, Kao CH. Relationship between pneumonia and cardiovascular diseases: A retrospective cohort study of the general population. Eur J Intern Med 2019; 59:39-45. [PMID: 30098854 DOI: 10.1016/j.ejim.2018.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the relationship between cardiovascular diseases (CVDs) and pneumonia in the general population. METHODS This retrospective observational study included two cohorts, namely CVD (n = 28,363) and non-CVD (n = 28,363) cohorts, which were matched by propensity score and examined for cases of pneumonia. Data were obtained from 2000 to 2011. In both cohorts, pneumonia risk was measured using multivariable Cox proportional hazard models. RESULTS With the non-CVD cohort as reference, the corresponding adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of pneumonia were 2.03 [1.77-2.31] for coronary artery disease, 4.11 [3.15-5.36] for heart failure, 3.21 [2.70-3.81] for cerebrovascular disease, 1.46 [1.07-1.98] for peripheral vascular disease, and 2.27 [2.01-2.56] for the CVD cohort. The cohort with comorbidities had a higher risk (all p < .05) of pneumonia compared with that without comorbidities, except for patients with the comorbidities of hypertension, hyperlipidemia, obesity, and liver disease. The aHR (95% CI) of pneumonia for antibiotic use was 1.26 (1.09-1.47). The aHRs of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) were 3.25 (95% CI = 1.04-10.1) and 2.95 (95% CI = 2.25-3.88), respectively. The aHRs (95% CI) were 1.78 (1.05-3.03) for intensive care unit (ICU) risk and 0.98 (0.96-0.99) for length of admission. CONCLUSION Pneumonia risk was associated with CVDs, especially heart failure, regardless of age, gender, comorbidities, and antibiotic use, particularly in elderly male patients. In addition, Patients with CVDs had a higher risk of CAP and HAP. The CVD cohort had a higher frequency of ICU admissions, but shorter admission lengths.
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Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Meiho University, Pingtung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Grdaduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Lee CH, Fang CC, Tsai LM, Gan ST, Lin SH, Li YH. Patterns of Acute Myocardial Infarction in Taiwan from 2009 to 2015. Am J Cardiol 2018; 122:1996-2004. [PMID: 30301543 DOI: 10.1016/j.amjcard.2018.08.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/28/2022]
Abstract
Most studies about the trends of acute myocardial infarction (AMI) were based on the data from Western countries. In recent years, little information is available from Asia since 2010. This study assessed the nationwide trends of AMI in Taiwan from 2009 to 2015. Using data from the Taiwan National Health Insurance Research Database, we identified 100,570 adult patients hospitalized for AMI from 2009 to 2015 and examined the temporal trends in the incidence of AMI. Overall, the age- and gender-adjusted incidence of AMI (per 100,000 persons) remained constant from 49.8 in 2009 to 50.7 in 2015. The incidence of AMI increased 30.3% and 29.4% in the young male and female populations (<55 years), whereas in other age groups, the incidence decreased or remained unchanged. The ratio of non-ST-segment elevation MI (NSTEMI) to STEMI incidence increased from 1.93 in 2009 to 2.47 in 2015. In young men (<55 years), a 49.8% increase in NSTEMI was observed. The prevalence of dyslipidemia increased significantly and it was the most common risk factor of AMI in young patients. Despite being increasingly used, percutaneous coronary intervention and secondary preventive medications, including dual antiplatelet therapy, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, β blocker and statin, were less prescribed for NSTEMI compared with STEMI. The in-hospital mortality of STEMI continued to decrease from 2013 to 2015 (8.8% to 7.6%), but not in NSTEMI (13.3% to 13.5%). In conclusion, our study revealed a marked increase of NSTEMI in young Taiwanese male population in recent years. Despite the increased utilization of percutaneous coronary intervention and guideline-recommended medications, the overall in-hospital mortality of NSTEMI remained stagnating in Taiwan.
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Li YH, Wang YC, Wang YC, Liu JC, Lee CH, Chen CC, Hsieh IC, Kuo FY, Huang WC, Sung SH, Chiu CZ, Hsu JC, Jen SL, Hwang JJ, Lin JL. 2018 Guidelines of the Taiwan Society of Cardiology, Taiwan Society of Emergency Medicine and Taiwan Society of Cardiovascular Interventions for the management of non ST-segment elevation acute coronary syndrome. J Formos Med Assoc 2018; 117:766-790. [PMID: 30017533 DOI: 10.1016/j.jfma.2018.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
In Taiwan, the incidence of non-ST segment elevation acute coronary syndrome (NSTE-ACS) continues to increase in recent years. The purpose of this guideline is to help health care professionals in Taiwan to use adequate tests and treatments for management of NSTE-ACS. For rapid diagnosis, in addition to history and physical examination, 0/3 h rapid diagnosis protocol with high sensitivity cardiac troponin assay is recommended in this guideline. Dual antiplatelet and anticoagulation therapies are important parts in the initial treatment. Risk stratification should be performed to identify high risk patients for early coronary angiography. Through evaluation of the coronary anatomy and other clinical factors, the decision for coronary revascularization, either by percutaneous coronary intervention or coronary artery bypass grafting, should be decided by the heart team. The duration of dual antiplatelet therapy should be given for at least 12 months after discharge. Other secondary preventive medications are also recommended for long term use.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital, Taichung, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ju-Chi Liu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital and Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Han Lee
- Department of Internal Medicine and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Chun-Chi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Feng-You Kuo
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Wei-Chun Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Chiung-Zuan Chiu
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Long Jen
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital and Taipei Medical University, New Taipei City, Taiwan.
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The Impact of Glyco-Metabolic Status in Patients Treated for Acute Coronary Syndrome. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2018; 39:37-50. [PMID: 30110257 DOI: 10.2478/prilozi-2018-0022] [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: 11/20/2022]
Abstract
Abstract
Objective: The aim of the study was to assess the prevalence of newly diagnosed diabetes in patients with acute coronary syndrome and estimate the relationship between stress hyperglycemia, glyco-regulation and newly diagnosed diabetes with hospital morbidity and mortality.
Methods: This was an observational study which included all patients hospitalized due to acute coronary syndrome (January 2015 until April 2017) at the University Clinic of Cardiology in Skopje, Macedonia. We analyzed demographic, clinical, biochemical variables and hospital morbidity and mortality. Five investigated groups were compared using a single biochemical parameter glycated hemoglobin (HgbA1c) depending on the presence of known diabetes before the acute event: 0-without DM (HgbA1c <5.6%), 1-newly diagnosed pre-diabetes (HgbA1c 5.6-6.5%), 2-newly diagnosed diabetes (HgbA1c ≥ 6.5%), 3-known well controlled diabetes (HgbA1c <7%) and 4-known un-controlled diabetes (HgbA1c ≥7%).
Results: 860 patients were analyzed. Impaired glucose metabolism was confirmed in 35% of patients, 9% of which were with newly diagnosed diabetes. Stress hyperglycemia was reported in 27.3% (3.6% were without diabetes). The highest values of stress hyperglycemia were reported in newly diagnosed and known un-controlled diabetes. In-hospital morbidity and mortality were 15% and 5% accordingly and the rate was highest in patients with newly diagnosed and known, but un-controlled diabetes. HgbA1c, stress hyperglycemia, and poor glycemic control have emerged as significant independent predictors of hospital morbidity and mortality in patients with acute coronary syndrome.
Conclusion: High prevalence of newly diagnosed diabetes was observed in patients with acute coronary syndrome. Stress hyperglycemia and failure to achieve glycemic control are independent predictors of hospital morbidity and mortality.
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Ding C, Zhang J, Li R, Wang J, Hu Y, Chen Y, Li X, Xu Y. Investigation of standardized administration of anti-platelet drugs and its effect on the prognosis of patients with coronary heart disease. Exp Ther Med 2017; 14:3207-3212. [PMID: 28966689 DOI: 10.3892/etm.2017.4903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/20/2016] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to explore the effect of adherence to standardized administration of anti-platelet drugs on the prognosis of patients with coronary heart disease. A total of 144 patients newly diagnosed with coronary heart disease at Lu'an Shili Hospital of Anhui Province (Lu'an, China) between June 2010 and June 2012 were followed up. Kaplan-Meier curves and the Cox regression model were used to evaluate the effects of standardized administration of anti-platelet drugs on primary and secondary end-point events. Of the patients with coronary heart disease, 109 (76%) patients took standard anti-platelet drugs following discharge. Kaplan-Meier curve and Cox regression analysis showed that standardized administration of anti-platelet drugs reduced the risk of primary end-point events (including all-cause mortality, non-lethal myocardial infarction and stroke) of patients with coronary heart disease [hazard ratio (HR)=0.307; 95% confidence interval (CI): 0.099-0.953; P=0.041) and all-cause mortality (HR=0.162; 95% CI: 0.029-0.890; P=0.036); however, standardized administration had no predictive value with regard to secondary end-point events. Standardized administration of anti-platelet drugs obviously reduced the risk of primary end-point events in patients with coronary heart disease, and further analysis showed that only all-cause mortality exhibited a statistically significant reduction.
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Affiliation(s)
- Chao Ding
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Jianhua Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Rongcheng Li
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Jiacai Wang
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Yongcang Hu
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Yanyan Chen
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Xiannan Li
- Department of Cardiology, Lu'an Shili Hospital of Anhui, Lu'an, Anhui 237006, P.R. China
| | - Yan Xu
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Wei CC, Lee SH. Predictors of Mortality in Elderly Patients with Non-ST Elevation Acute Coronary Syndrome - Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry. ACTA CARDIOLOGICA SINICA 2017; 33:377-383. [PMID: 29033508 PMCID: PMC5534417 DOI: 10.6515/acs20170126a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Some difficulties and variations remain associated with the care of elderly patients with non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS We included 1470 patients from a Taiwan nationwide registry who fulfilled the criteria of NSTE-ACS, and stratified these patients by age and evaluated the treatment, complications and outcomes in different age groups. Furthermore, we analyzed risk factors and standards of care to determine the predictors of mortality. RESULTS Patients ≥ 75 years of age (n = 396) had significantly higher incidences of 90-day mortality [odd ratio (OR) = 4.5 (1.2-16.3), p = 0.023] and 1-year mortality [OR = 4.9 (2.0-12.3), p = 0.001] compared with those patients 45-64 years of age (n = 595). In the patients ≥ 75 years of age, previous myocardial infarction (MI) [OR = 3.3 (1.1-9.8), p = 0.035], statins [OR = 0.35 (0.1-0.9), p = 0.037], left ventricular ejection fraction (LVEF) < 35% [OR = 3.9 (1.5-10.4), p = 0.006] were associated with 90-day mortality. Furthermore, previous MI [OR = 4.0 (1.3-12.6), p = 0.019] was an independent predictor of 90-day mortality. Age [OR = 1.1 (1.03-1.2), p = 0.002], previous MI [OR = 2.2 (1.1-4.4), p = 0.034], angiotensin-converting enzyme inhibitor or angiotensin receptor blocker [OR = 0.5 (0.3-0.9), p = 0.028], and LVEF < 35% [OR = 4.3 (1.9-9.5), p < 0.001] were associated with 1-year mortality. Furthermore, previous MI [OR = 2.6 (1.1-6.5), p = 0.037], LVEF < 35% [OR = 4.7 (1.5-14.4), p = 0.007] and percutaneous coronary intervention(PCI) or not [OR = 0.3 (0.1-0.9), p = 0.021] were independent predictors of 1-year mortality. CONCLUSIONS Previous MI, LVEF < 35% and PCI or not could predict 1-year mortality in advanced elderly patients with NSTE-ACS. Despite their elevated morbidities and complications, PCI was still beneficial for these patients.
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Affiliation(s)
- Cheng-Chun Wei
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei
| | - Shih-Huang Lee
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Su TH, Chang SH, Chen PC, Chan YL. Temporal Trends in Treatment and Outcomes of Acute Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Observational Study. J Am Heart Assoc 2017; 6:e004525. [PMID: 28298371 PMCID: PMC5524002 DOI: 10.1161/jaha.116.004525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute myocardial infarction is a major cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD); however, temporal trends in the management and clinical outcomes of these patients remain unclear. METHODS AND RESULTS We conducted an observational study by using a representative sample of 1 million beneficiaries from the Taiwan National Health Insurance Research Database. Comorbidities, in-hospital treatment, and outcomes were compared for patients with acute myocardial infarction with and without COPD between 2004 and 2013. Temporal trends in treatment and outcomes were analyzed. We included 6770 patients admitted to hospitals with acute myocardial infarction diagnoses, of whom 1921 (28.3%) had COPD. Fewer patients with COPD received β-blockers (adjusted odds ratio 0.66, 95% CI 0.59-0.74), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (adjusted odds ratio 0.83, 95% CI 0.73-0.93), statins, anticoagulants, dual antiplatelets, and coronary interventions. These patients had higher mortality (in hospital: adjusted hazard ratio 1.25 [95% CI 1.11-1.41]; 1 year: adjusted hazard ratio 1.20 [95% CI 1.09-1.32]) and respiratory failure risk during admission. Temporal trends showed little improvement in mortality in patients with COPD over 10 years. Multivariable logistic regression indicated that dual antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, coronary angiography, and coronary artery bypass grafting surgery were significantly correlated with improved mortality in patients with COPD. CONCLUSIONS In Taiwan, a lower proportion of patients with COPD received evidence-based therapies for acute myocardial infarction than did patients without COPD, and their clinical outcomes were inferior. Limited improvement in mortality was observed over the preceding 10 years and is attributable to the underuse of evidence-based treatments.
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Affiliation(s)
- Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
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Chan L, Chen CH, Hwang JJ, Yeh SJ, Shyu KG, Lin RT, Li YH, Liu LZ, Li JZ, Shau WY, Weng TC. Cost-effectiveness of amlodipine compared with valsartan in preventing stroke and myocardial infarction among hypertensive patients in Taiwan. Int J Gen Med 2016; 9:175-82. [PMID: 27330323 PMCID: PMC4898031 DOI: 10.2147/ijgm.s102095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Hypertension is a major risk factor for strokes and myocardial infarction (MI). Given its effectiveness and safety profile, the calcium channel blocker amlodipine is among the most frequently prescribed antihypertensive drugs. This analysis was conducted to determine the costs and quality-adjusted life years (QALYs) associated with the use of amlodipine and valsartan, an angiotensin II receptor blocker, in preventing stroke and MI in Taiwanese hypertensive patients. A state transition (Markov) model was developed to compare the 5-year costs and QALYs for amlodipine and valsartan. Effectiveness data were based on the NAGOYA HEART Study, local studies, and a published meta-analysis. Utility data and costs of MI and stroke were retrieved from the published literature. Medical costs were based on the literature and inflated to 2011 prices; drug costs were based on National Health Insurance prices in 2014. A 3% discount rate was used for costs and QALYs and a third-party payer perspective adopted. One-way sensitivity and scenario analyses were conducted. Compared with valsartan, amlodipine was associated with cost savings of New Taiwan Dollars (NTD) 2,251 per patient per year: costs were NTD 4,296 and NTD 6,547 per patient per year for amlodipine and valsartan users, respectively. Fewer cardiovascular events were reported in patients receiving amlodipine versus valsartan (342 vs 413 per 10,000 patients over 5 years, respectively). Amlodipine had a net gain of 58 QALYs versus valsartan per 10,000 patients over 5 years. Sensitivity analyses showed that the discount rate and cohort age had a larger effect on total cost and cost difference than on QALYs. However, amlodipine results were more favorable than valsartan irrespective of discount rate or cohort age. When administered to Taiwanese patients for hypertension control, amlodipine was associated with lower cost and more QALYs compared with valsartan due to a lower risk of stroke and MI events.
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Affiliation(s)
- Lung Chan
- Department of Neurology, Shuang-Ho Hospital, School of Medicine, College of Medicine, Taipei Medical University, New Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Internal Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - San-Jou Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kou-Gi Shyu
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ruey-Tay Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Taiwan
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Wei CC, Shyu KG, Cheng JJ, Lo HM, Chiu CZ. Diabetes and Adverse Cardiovascular Outcomes in Patients with Acute Coronary Syndrome - Data from Taiwan's Acute Coronary Syndrome Full Spectrum Data Registry. ACTA CARDIOLOGICA SINICA 2016; 32:31-8. [PMID: 27171367 DOI: 10.6515/acs20150322a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major public health problem in Taiwan and is associated with poor outcomes in patients with coronary artery disease. However, the role of DM in outcomes for patients with acute coronary syndrome (ACS) has not been clearly defined in Taiwan. This study utilized the Taiwan ACS registry, and characterized the clinical features, risk factors, hospital therapies, hospital outcomes, and events within one year post-discharge to identify the effect of DM on adverse cardiovascular outcomes in ACS patients. METHODS A total of 3183 patients were enrolled from a Taiwan nationwide registry, from October 2008 to January 2010. We compared these ACS patients with and without DM in terms of baseline demographics, clinical presentation, risk factors, medical treatment, intervention, and outcomes in the following 12 months. The primary endpoint was a composite outcome that included death, re-myocardial infarction and stroke within a 12-month period. The secondary endpoint consisted of the combined results of death, re-myocardial infarction, stroke, re-vascularization, and re-hospitalization over 12 months. RESULTS Overall, 2766 (86.8%) ACS patients were analyzed in this study. Of that total, 1000 (36%) of them were diabetes patients. Over the course of one year of follow-up, the DM patients had higher probabilities of all-cause death (10.1% vs. 6.06%, p < 0.05), for both primary outcomes (15.7% vs. 10.93%, p < 0.05) and secondary outcomes (51.6% vs. 42.41%, p < 0.05). Logistic regression analysis showed that patients in the DM group were at a higher risk of all-cause death and the primary outcomes, after adjusting the confounding variables (odds ratio was 1.9 and 1.6 respectively, p < 0.01). For those patients suffering from primary outcomes, the mean survival time was 34.7 ± 10.4 days in the Non-DM group and 33.3 ± 11.8 days in the DM group (p < 0.05). The log rank test showed the two survival curves were significantly distinctive (p < 0.05). Cox regression analysis showed the odds ratio for all-cause death and the primary outcomes were 1.66 and 1.5, respectively (p < 0.05). CONCLUSIONS Compared to patients without DM, ACS patients with diabetes had significantly worse outcomes in terms of all-cause death and the combined results for death, re-infarction and stroke.
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Affiliation(s)
- Cheng-Chun Wei
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital
| | - Kou-Gi Shyu
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei
| | - Jun-Jack Cheng
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Division of Cardiology; ; School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hei-Ming Lo
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Division of Cardiology
| | - Chiung-Zuan Chiu
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Division of Cardiology
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Zeymer U, Becher A, Jennings E, Johansson S, Westergaard M. Systematic review of the clinical impact of dual antiplatelet therapy discontinuation after acute coronary syndromes. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:522-531. [DOI: 10.1177/2048872616648467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Institut für Herzinfarktforschung, Germany
| | - Anja Becher
- Research and Evaluation Unit, Oxford PharmaGenesis Ltd, UK
- School of Medicine, Pharmacy and Health, Durham University, UK
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Wei CC, Shyu KG, Cheng JJ, Lo HM, Chiu CZ. The Relation between the Timing of Percutaneous Coronary Intervention and Outcomes in Patients with Acute Coronary Syndrome with Routine Invasive Strategy - Data from Taiwan Acute Coronary Syndrome Full Spectrum Data Registry. ACTA CARDIOLOGICA SINICA 2016; 32:39-48. [PMID: 27122929 DOI: 10.6515/acs20150722a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Several large trials have indicated that a routine invasive strategy was favored for high-risk patients with non-ST-elevation acute coronary syndromes. However, the optimal timing for this intervention is unclear. METHODS We included patients with unstable angina or non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) from the Taiwan acute coronary syndrome registry. Thrombolysis in Myocardial Infarction (TIMI) score was used to stratify our patients into three groups: low (TIMI 0-2), intermediate (TIMI 3-4) and high risk (TIMI 5-7).We analyzed outcomes according to the timing of PCI. RESULTS Overall, 984 patients were included in this study. For primary outcomes including cardiac death and recurrent myocardial infarction, early PCI within 24 hours did not show benefits over late PCI (24-72 or > 72 hours) (p > 0.05) in the low and intermediate risk groups. However, in the high risk group, patients who underwent PCI after 72 hours had significantly worse primary outcomes than those who underwent PCI within 24-72 hours. For secondary outcomes including non-cardiac death, unplanned revascularization, and major bleeding, the events rate was significantly higher for early or delayed PCI in low-risk patients when compared with patients who underwent PCI within 24-72 hours. CONCLUSIONS In our study, for high-risk NSTE-ACS patients, PCI within 24-72 hours from symptom onset is demonstrably the optimum time for PCI. Delayed PCI over 72 hours is associated with the worst outcomes and should be avoided. For patients with low risks, routine early PCI < 24 hours after PCI is not beneficial. KEY WORDS Acute coronary syndrome; Early invasive strategy.
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Affiliation(s)
- Cheng-Chun Wei
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital
| | - Kou-Gi Shyu
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei
| | - Jun-Jack Cheng
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Division of Cardiology; ; School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hei-Ming Lo
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Division of Cardiology
| | - Chiung-Zuan Chiu
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital; ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Division of Cardiology
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Lai CC, Chang KC, Liao PC, Wu CT, Lai WT, Wu CJ, Chang SC, Mar GY. Effects of Door-to-Balloon Times on Outcomes in Taiwanese Patients Receiving Primary Percutaneous Coronary Intervention: A Report of Taiwan Acute Coronary Syndrome Full Spectrum Registry. ACTA CARDIOLOGICA SINICA 2016; 31:215-25. [PMID: 27122873 DOI: 10.6515/acs20140721e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The impact of door-to-balloon (DTB) time on patient outcomes is unclear in a Taiwanese population receiving primary percutaneous coronary intervention (PCI). The study aimed to investigate the relationship between stratified DTB times and outcomes through analysis of the database from the Taiwan acute coronary syndrome full spectrum registry. METHODS Relevant data were collected from case report forms of patients receiving primary PCI who were categorized as group 1, 2, 3, and 4 according to the DTB time < 45, 45-90, 91-135, and > 135 minutes, respectively. The differences were analyzed by using ANOVA and Kaplan-Meier analyses. RESULTS There were significant variations in DTB times at baseline, which included patients salvaged at centers, patients with prior cardiovascular disease, and those patients with different coronary artery flows (p < 0.01) separated into 4 groups (n = 189, 443, 299, and 401, respectively). The in-hospital adverse event rates were identical among the 4 groups except for a higher rate of acute renal failure and a longer hospital stay observed in group 4 (p < 0.01). The results showed no decrease in the incidences of repeated revascularization, major adverse cardiac event, or cardiovascular composite at 1 year in group 1. CONCLUSIONS This study suggested that the DTB time is not a good determinant for outcomes in Taiwanese patients receiving primary PCI. KEY WORDS Acute myocardial infarction; Cardiovascular outcome; Door-to-balloon time; Myocardial ischemia; Percutaneous coronary intervention.
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Affiliation(s)
- Chi-Cheng Lai
- Cardiovascular Center, Kaohsiung Veterans General Hospital; ; Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung; ; School of Medicine, National Yang-Ming University; ; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Kuan-Cheng Chang
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung
| | - Pen-Chih Liao
- Division of Cardiology, Cardiovascular Center, Far Eastern Memorial Hospital, Taipei
| | - Chia-Tung Wu
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital; ; Faculty of Medicine, College of Medicine, Kaohsiung, Medical University
| | - Chiung-Jen Wu
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan; ; Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Shu-Chen Chang
- Division of Biostatistics, Institute of Public Health, National Yang-Ming University, Taipei
| | - Guang-Yuan Mar
- Cardiovascular Center, Kaohsiung Veterans General Hospital; ; College of Health and Nursing, MeiHo University, Pingtung, Taiwan
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CHADS2 score predicts risk of contrast-induced nephropathy in stable coronary artery disease patients undergoing percutaneous coronary interventions. J Formos Med Assoc 2016; 115:501-9. [PMID: 26830105 DOI: 10.1016/j.jfma.2015.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 12/03/2015] [Accepted: 12/10/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/PURPOSE To investigate the correlation between the CHADS2 score and risk of contrast-induced nephropathy (CIN), we conducted a retrospective study in patients who underwent elective percutaneous coronary intervention (PCI) and compared its accuracy with previous scoring systems. METHODS A total of 539 patients who underwent elective PCI were enrolled. Based on their underlying diseases, such as hypertension, diabetes, and kidney disease, CHADS2 score, R2CHADS2 score, and Mehran's risk score were calculated for each patient. Incidence of CIN was defined as a rise in serum creatinine >0.5 mg/dL or >25% increase in baseline within 48 hours after PCI. All study participants were followed up until October 2014, or until the occurrence of major adverse cardiovascular events (MACEs). RESULTS Overall, 55 cases (10.2%) of CIN and 90 cases (16.7%) of MACEs were identified after participants were followed up for 1.57 ± 1.46 years. The study cohort was divided into three groups according to CHADS2 scores: score 0, score 1-2, and score 3-6. In multivariate analysis, an increase of 1 point in the CHADS2 score was independently associated with a 37% increase in the risk of CIN (odds ratio, 1.37; 95% confidence interval, 1.00-1.87; p = 0.048) and a 49% increase in MACEs (hazard ratio, 1.49; 95% confidence interval, 1.18-1.88, p = 0.001). In pairwise comparison, the discriminatory performance of CHADS2 score was not inferior to either R2CHADS2 score (p = 0.226) or Mehran's risk score (p = 0.075). CONCLUSION CHADS2 score could be a simple and useful predictor for CIN in patients undergoing elective PCI.
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Chan MY, Du X, Eccleston D, Ma C, Mohanan PP, Ogita M, Shyu KG, Yan BP, Jeong YH. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol 2016; 202:861-9. [DOI: 10.1016/j.ijcard.2015.04.073] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
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Serebruany VL, Tomek A, Pokov AN, Kim MH. Clopidogrel, prasugrel, ticagrelor or vorapaxar in patients with renal impairment: do we have a winner? Expert Rev Cardiovasc Ther 2015; 13:1333-44. [PMID: 26513059 DOI: 10.1586/14779072.2015.1101343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The optimal utilization of antiplatelet therapy in patients with renal impairment (RI) following acute coronary syndromes (ACS) represents an urgent, unmet and yet unsolved need with regards to the choice of agents, duration of treatment and potential dose/regimen adjustment. The lack of any large randomized trials designed and powered specifically in such high-risk patients, absence of the uniformed efficacy and safety data reporting policy to the FDA and endless overoptimistic publications based on post hoc analyses of primary trials sometimes exaggerating benefits and hiding risks, clouds reality. In addition, triaging RI patients is problematic due to ongoing kidney deterioration and the fact that such patients are prone to both vascular occlusions and bleeding. The authors summarize available FDA-confirmed evidence from the latest trials with approved antiplatelet agents, namely clopidogrel (CAPRIE, CURE, CREDO, CLARITY, CHARISMA); prasugrel (TRITON, TRILOGY); ticagrelor (PLATO, and PEGASUS); and vorapaxar (TRACER and TRA2P) in RI patient cohorts on top of aspirin as part of dual antiplatelet therapy (DAPT). We deliberately avoided any results unless they were verified by the FDA, with the exception of the recent PEGASUS, since Agency reviews are not yet available. Despite differences among the trials and DAPT choices, RI patients universally experience much higher (HR = 1.3-3.1) rates of primary endpoint events, and bleeding risks (HR = 1.7-3.6). However, only ticagrelor increases creatinine and uric acid levels above that of clopidogrel; has the worst incidence of serious adverse events, more adverse events, and inferior outcomes in patients with severe (eGFR <30 ml/min), especially in the lowest (eGFR <15 ml/min) RI subsets. Clopidogrel, prasugrel and vorapaxar appear safer. Moreover, less aggressive half dose (5 mg/daily) prasugrel and strict DAPT, are well justified in RI, but not predominantly triple strategies with vorapaxar as tested in TRA2P and especially in TRACER. In conclusion, data from clinical trials, their sub-studies and affiliated FDA reviews indicate that RI cause more vascular occlusions and bleeding in ACS patients treated with DAPT. Among the novel antiplatelet agents, prasugrel and vorapaxar, but probably not ticagrelor, offer advantage in RI patients.
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Affiliation(s)
- Victor L Serebruany
- a Osler Medical Center , Towson , MD , USA.,b Department of Neurology , Johns Hopkins , Towson , MD , USA
| | - Ales Tomek
- c Department of Neurology , University of Prague , Prague , Czech Republic
| | | | - Moo Hyun Kim
- d Department of Cardiology , Dong-A University , Busan , Korea
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D'Souza M, Sarkisian L, Saaby L, Poulsen TS, Gerke O, Larsen TB, Diederichsen ACP, Jangaard N, Diederichsen SZ, Hosbond S, Hove J, Thygesen K, Mickley H. Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays. Am J Med 2015; 128:852-60. [PMID: 25820165 DOI: 10.1016/j.amjmed.2015.01.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 01/24/2015] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been studied prospectively in unselected hospital patients. METHODS During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI, and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System. RESULTS Of 3762 consecutive patients, 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67%, and STEMI in 26%. The NSTEMI patients were older, more frequently women, and had more comorbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI, and 25% of STEMI patients. Age-adjusted log-rank statistics revealed differences in mortality: NSTEMI vs unstable angina pectoris (P = .0091) and NSTEMI vs STEMI (P = .0045). CONCLUSIONS The application of the universal definition together with the use of a contemporary troponin assay seems to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this, NSTEMI patients have a sustained higher mortality than patients with STEMI.
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Affiliation(s)
- Maria D'Souza
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Laura Sarkisian
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tina S Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital and Center of Health Economics Research, Odense, Denmark
| | - Torben B Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Nikolaj Jangaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Susanne Hosbond
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens Hove
- Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Huo Y, Thompson P, Buddhari W, Ge J, Harding S, Ramanathan L, Reyes E, Santoso A, Tam LW, Vijayaraghavan G, Yeh HI. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. Int J Cardiol 2014; 183:63-75. [PMID: 25662044 DOI: 10.1016/j.ijcard.2014.11.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022]
Abstract
Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
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Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China.
| | - Peter Thompson
- University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Wacin Buddhari
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Scott Harding
- Wellington Cardiovascular Research Group and School of Biological Sciences, Victoria University, Wellington, New Zealand
| | | | - Eugenio Reyes
- University of the Philippines, Philippine General Hospital-Section of Cardiology, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology - Vascular Medicine, Faculty of Medicine, University of Indonesia and National Cardiovascular Center, Harapan Kita, Indonesia
| | | | | | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
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Cheng CL, Lee CH, Chen PS, Li YH, Lin SJ, Yang YHK. Validation of acute myocardial infarction cases in the national health insurance research database in taiwan. J Epidemiol 2014; 24:500-7. [PMID: 25174915 PMCID: PMC4213225 DOI: 10.2188/jea.je20140076] [Citation(s) in RCA: 377] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to determine the validity of acute myocardial infarction (AMI) diagnosis coding in the National Health Insurance Research Database (NHIRD) by cross-comparisons of discharge diagnoses listed in the NHIRD with those in the medical records obtained from a medical center in Taiwan. Methods This was a cross-sectional study comparing records in the NHIRD and discharge notes in one medical center (DNMC) in the year 2008. Positive predictive values (PPVs) for AMI diagnoses were evaluated by reviewing the relevant clinical and laboratory data recorded in the discharge notes of the medical center. Agreement in comorbidities, cardiac procedures, and antiplatelet agent (aspirin or clopidogrel) prescriptions between the two databases was evaluated. Results We matched 341 cases of AMI hospitalizations from the two databases, and 338 cases underwent complete chart review. Of these 338 AMI cases, 297 were confirmed with clinical and lab data, which yielded a PPV of 0.88. The consistency rate for coronary intervention, stenting, and antiplatelet prescription at admission was high, yielding a PPV over 0.90. The percentage of consistency in comorbidity diagnoses was 95.9% (324/338) among matched AMI cases. Conclusions The NHIRD appears to be a valid resource for population research in cardiovascular diseases.
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Affiliation(s)
- Ching-Lan Cheng
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University
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Lin TH, Hsin HT, Wang CL, Lai WT, Li AH, Kuo CT, Hwang JJ, Chiang FT, Chang SC, Chang CJ. Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. BMC Nephrol 2014; 15:66. [PMID: 24758190 PMCID: PMC4003515 DOI: 10.1186/1471-2369-15-66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/16/2014] [Indexed: 12/14/2022] Open
Abstract
Background The optimal revascularization strategy for patients with impaired glomerular filtration rate (IGFR) has not been established in acute coronary syndrome (ACS). We investigated the prognosis and impact of IGFR and invasive strategy on the cardiovascular outcomes in the ACS population. Methods In a Taiwan national-wide registry, 3093 ACS patients were enrolled. The invasive strategy was defined as patients with ST-elevation ACS (STE-ACS) undergoing primary angioplasty or fibrinolysis or coronary angiography with intent to revascularization performed within 72 hours of symptom onset in non-ST-elevation ACS (NSTE-ACS). IGFR was defined as an estimated GFR of less than 60 ml/min per 1.73 m2. Primary endpoint was a composite of death, non-fatal myocardial infarction or stroke at one year. Results Patients with IGFR (n = 1226) had more comorbidities but received less evidence-based medications during admission than those without IGFR (n = 1867). The primary endpoint-free survival rate is lower in the IGFR patients, in the whole, STE-ACS and NSTE-ACS population (all log-rank tests p < 0.01). Cox regression analysis revealed IGFR subjects had higher primary endpoint after adjusting by age, sex, medication at discharge and traditional risk factors (all p < 0.01). Kaplan–Meier curves showed IGFR patients without invasive strategy had the worst outcome in the STE-ACS and NSTE-ACS population (both p < 0.01). The invasive strategies, either with early angiography only or angioplasty, were associated with reduced primary endpoints among IGFR patients in the NSTE-ACS population (both p ≦ 0.024). Conclusions IGFR patients suffering from ACS had poor prognosis and an invasive strategy could improve cardiovascular outcome in the NSTE-ACS population.
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Affiliation(s)
| | | | | | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No,100, Tzyou 1st Road, Kaohsiung 80708, Taiwan.
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