1
|
Varian FL, Parker WAE, Fotheringham J, Storey RF. Treatment inequity in antiplatelet therapy for ischaemic heart disease in patients with advanced chronic kidney disease: releasing the evidence vacuum. Platelets 2023; 34:2154330. [DOI: 10.1080/09537104.2022.2154330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Frances L. Varian
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK and
| | - William A. E. Parker
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK and
| | - James Fotheringham
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert F. Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK and
| |
Collapse
|
2
|
Chong CH, Au EH, Davies CE, Jaure A, Howell M, Lim WH, Craig JC, Teixeira-Pinto A, Wong G. Long-term Trends in Infection-Related Mortality in Adults Treated With Maintenance Dialysis. Am J Kidney Dis 2023; 82:597-607. [PMID: 37330132 DOI: 10.1053/j.ajkd.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
RATIONALE & OBJECTIVE Infection is 1 of the top 3 causes of death in patients receiving maintenance dialysis. We evaluated the trends over time and risk factors for infection-related deaths among people receiving dialysis. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS We included all adults who began dialysis between 1980 and 2018 in Australia and New Zealand. EXPOSURE Age, sex, dialysis modality, and dialysis era. OUTCOME Infection-related death. ANALYTICAL APPROACH Incidence was described and standardized mortality ratios (SMR) calculated for infection-related death. Fine-Gray subdistribution hazards models were fitted, with non-infection-related death and kidney transplantation treated as competing events. RESULTS The study comprised 46,074 patients who received hemodialysis and 20,653 who were treated with peritoneal dialysis who were followed for 164,536 and 69,846 person-years, respectively. There were 38,463 deaths during the follow-up period, 12% of which were ascribed to infection. The overall rate of mortality from infection (per 10,000 person-years) was 185 and 232 for patients treated with hemodialysis and peritoneal dialysis, respectively. The rates were 184 and 219 for males and females, respectively; and 99, 181, 255, and 292 for patients aged 18-44, 45-64, 65-74, 75 years and over, respectively. The rates were 224 and 163 for those commencing dialysis in years 1980-2005 and 2006-2018, respectively. The overall SMR declined over time, from 37.1 (95% CI, 35.5-38.8) in years 1980-2005 to 19.3 (95% CI, 18.4-20.3) in years 2006-2018, consistent with the declining 5-year SMR trend (P<0.001). Infection-related mortality was associated with being female, older age, and Aboriginal and/or a Torres Strait Islander or Māori. LIMITATIONS Mediation analyses defining the causal relationships between infection type and infection-related death could not be undertaken as disaggregating the data was not feasible. CONCLUSIONS The excess risk of infection-related death in patients on dialysis has improved substantially over time but remains more than 20 times higher than in the general population.
Collapse
Affiliation(s)
- Chanel H Chong
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney.
| | - Eric H Au
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney; Centre for Transplant and Renal Research, Westmead Hospital, Sydney
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Allison Jaure
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney
| | - Martin Howell
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney
| | - Wai H Lim
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital Unit, Perth, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Armando Teixeira-Pinto
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney; Centre for Kidney Research, the Children's Hospital at Westmead, Sydney; Centre for Transplant and Renal Research, Westmead Hospital, Sydney
| |
Collapse
|
3
|
Engelbertz C, Feld J, Makowski L, Lange SA, Günster C, Dröge P, Ruhnke T, Gerß J, Reinecke H, Köppe J. Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis. Clin Kidney J 2023; 16:1947-1956. [PMID: 37915929 PMCID: PMC10616503 DOI: 10.1093/ckj/sfad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 11/03/2023] Open
Abstract
Background Survivors of myocardial infarction have an elevated risk of long-term mortality. We sought to evaluate guideline-directed medical treatment and its impact on long-term mortality in survivors of ST-elevation myocardial infarction (STEMI) according to their chronic kidney disease (CKD) stage. Methods Using German health insurance claims data, 157 663 hospitalized survivors of STEMI were identified. Regarding different CKD stages, we retrospectively analysed the filled prescriptions of platelet inhibitors (PAI)/oral anticoagulation, statins, beta-blocker and angiotensin-converting enzyme inhibitors/angiotensin II type 1 receptor antagonists (ACE-I/AT1-A) and their association with long-term mortality. Results Prescription rates for all four guideline-directed drugs were highest in patients without or with mild CKD and lowest in patients on dialysis. They dropped from 73.4% to 39.2% in patients without CKD and from 47.1% to 29% in patients on dialysis within the 5-year follow-up period. Mortality rates were dramatically increased in patients with CKD compared with patients without CKD (5-year mortality: no CKD, 16.7%; CKD stage 3, 47.1%; CKD stage 5d, 69.7%). Filled prescriptions of at least one drug class [one drug: hazard ratio (HR) 0.70, 95% confidence interval (95% CI) 0.66-0.74; four drugs: HR 0.28, 95% CI 0.27-0.30; P < .001 for both] as well as the distinct drug classes (statins: HR 0.55, 95% CI 0.54-0.56; ACE-I/AT1-A: HR 0.68, 95% CI 0.67-0.70; beta-blocker: HR 0.87, 95% CI 0.85-0.90; PAI/oral anticoagulation: HR 0.97, 95% CI 0.95-1.00; all P < .05) improved long-term mortality. Conclusions An improved long-term guideline-recommended drug therapy after STEMI regardless of renal impairment might lead to beneficial effects on long-term mortality.
Collapse
Affiliation(s)
- Christiane Engelbertz
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Lena Makowski
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Stefan A Lange
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | | | | | | | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| |
Collapse
|
4
|
Engelbertz C, Feld J, Makowski L, Kühnemund L, Fischer AJ, Lange SA, Günster C, Dröge P, Ruhnke T, Gerß J, Freisinger E, Reinecke H, Köppe J. Contemporary in-hospital and long-term prognosis of patients with acute ST-elevation myocardial infarction depending on renal function: a retrospective analysis. BMC Cardiovasc Disord 2023; 23:62. [PMID: 36732721 PMCID: PMC9896822 DOI: 10.1186/s12872-023-03084-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiovascular disease is often associated with chronic kidney disease (CKD), resulting in an increased risk for poor outcome. We sought to determine short-term mortality and overall survival in ST-elevation myocardial infarction (STEMI) patients with different stages of CKD. METHODS In our retrospective cohort study with health insurance claims data of the Allgemeine Ortskrankenkasse (AOK), anonymized data of all STEMI patients hospitalized between 2010 and 2017 were analyzed regarding presence and severity of concomitant CKD. RESULTS A total of 175,187 patients had an index-hospitalisation for STEMI (without CKD: 78.6% patients, CKD stage 1: 0.8%, CKD stage 2: 4.8%, CKD stage 3: 11.7%, CKD stage 4: 2.8%, CKD stage 5: 0.7%, CKD stage 5d: 0.6%). Patients with CKD were older and had more co-morbidities than patients without CKD. With increasing CKD severity, patients received less revascularization therapies (91.2%, 85.9%, 87.0%, 81.8%, 71.7%, 76.9% and 78.6% respectively, p < 0.001). After 1 year, guideline-recommended medications were prescribed less frequently in advanced CKD (83.4%, 79.3%, 81.5%, 74.7%, 65.0%, 59.4% and 53.7%, respectively, p < 0.001). CKD stages 4, 5 and 5d as well as chronic limb threatening ischemia (CLTI) were associated with decreased overall survival [CKD stage 4: hazard ratio (HR) 1.72; 95% CI 1.66-1.78; CKD stage 5: HR 2.55; 95% CI 2.37-2.73; CKD stage 5d: 5.64; 95% CI 5.42-5.86; CLTI: 2.06; 95% CI 1.98-2.13; all p < 0.001]. CONCLUSIONS CKD is a frequent co-morbidity in patients with STEMI and is associated with a worse prognosis especially in advanced stages. Guideline-recommended therapies in patients with STEMI and CKD are still underused.
Collapse
Affiliation(s)
- Christiane Engelbertz
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany.
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Lena Makowski
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Leonie Kühnemund
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Alicia Jeanette Fischer
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Stefan A Lange
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | | | | | | | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Eva Freisinger
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| |
Collapse
|
5
|
Fujii T, Ikari Y. Additional effect of hemodialysis on mortality estimated from renal function in ischemic heart disease. Future Cardiol 2022; 18:857-865. [PMID: 36169210 DOI: 10.2217/fca-2022-0036] [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: 01/26/2023] Open
Abstract
Aim: The present study examined whether hemodialysis in patients with ischemic heart disease increases mortality more than the estimated mortality from renal function. Patients & methods: A total of 1621 patients with angina pectoris (n = 815), ST-elevation myocardial infarction (n = 421) or non-ST-elevation acute coronary syndrome (n = 385) were examined. An estimated mortality curve according to the estimated glomerular filtration rate was drawn using the marginal effect from the logit model. The probability of mortality in patients with hemodialysis was plotted on these curves. Results: The probability of mortality in patients undergoing hemodialysis crossed the estimated mortality curves at the estimated glomerular filtration rate of 5.7 ml/min/1.73 m2 in angina pectoris, 31.3 ml/min/1.73 m2 in STEMI and 45.9 ml/min/1.73 m2 in non-ST-elevation acute coronary syndrome. Conclusion: Hemodialysis does not have an additional adverse impact on the estimated mortality.
Collapse
|
6
|
Trajectories of Blood Pressure in Patients with Established Coronary Artery Disease over 20 years. Int J Hypertens 2022; 2022:2086515. [PMID: 36225816 PMCID: PMC9550506 DOI: 10.1155/2022/2086515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate changes in blood pressure (BP) values in patients with established coronary artery disease (CAD) over 20 years (1997–2017). Materials and Methods Consecutive patients aged <71 years and hospitalized for acute coronary syndrome or myocardial revascularization procedures were recruited and interviewed 6–18 months after their discharge from the hospital. BP was measured in 1997–1998, 1999–2000, 2006–2007, 2011–2013, and 2016–2017. The same five hospitals took part in the surveys at each time point. Results We examined 412 patients in 1997–1998, 427 in 1999–2000, 422 in 2006–2007, 462 in 2011–2013, and 272 in 2016–2017. The proportion of patients with BP at the recommended goal was 49.2% in 1997–98, 44.5% in 1999–2000, 44.7% in 2006–07, 51.1% in 2011–13, and 58.8% in 2016–17 (p < 0.001). Mean systolic and diastolic BP decreased significantly independent of age, sex, and education (systolic BP: 137.9 ± 21.4 mmHg in 1997–98, 139.5 ± 21.6 mmHg in 1999–2000, 136.1 ± 20.3 mmHg in 2006–07, 134.8 ± 22.0 mmHg in 2011–13, and 134.2 ± 18.6 mmHg in 2016–17, p < 0.001; diastolic BP: 83.4 ± 11.0 mmHg in 1997–98, 84.8 ± 12.0 mmHg in 1999–2000, 85.2 ± 11.0 mmHg in 2006–07, 80.9 ± 12.5 mmHg in 2011–13, and 81.1 ± 10.4 mmHg in 2016–17; p < 0.001). Conclusion The analysis of five multicenter surveys provides evidence of a decrease in BP in patients with established CAD over two decades. This trend is independent of age, sex, and the education level of the patients.
Collapse
|
7
|
Chaitman BR, Cyr DD, Alexander KP, Pracoń R, Bainey KR, Mathew A, Acharya A, Kunichoff DF, Fleg JL, Lopes RD, Sidhu MS, Anthopolos R, Rockhold FW, Stone GW, Maron DJ, Hochman JS, Bangalore S. Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial. Circ Cardiovasc Interv 2022; 15:e012103. [PMID: 35973009 PMCID: PMC10865178 DOI: 10.1161/circinterventions.122.012103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease) reported an initial invasive treatment strategy did not reduce the risk of death or nonfatal myocardial infarction (MI) compared with a conservative treatment strategy in patients with advanced chronic kidney disease, stable coronary disease, and moderate or severe myocardial ischemia. The cumulative frequency of different MI type after randomization and subsequent prognosis have not been reported. METHODS MI classification was based on the Third Universal Definition for MI. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary MI definition used cTn (cardiac troponin); both definitions included elevated biomarker-only events with higher thresholds than nonprocedural MIs. The cumulative frequency of MI type according to treatment strategy was determined. The association of MI with subsequent all-cause death and new dialysis initiation was assessed by treating MI as a time-dependent covariate. RESULTS The 3-year incidence of type 1 or 2 MI with the primary MI definition was 11.2% in invasive treatment strategy and 13.6% in conservative treatment strategy (hazard ratio [HR], 0.66 [95% CI, 0.42-1.02]). Procedural MIs were more frequent in invasive treatment strategy and accounted for 9.8% and 28.3% of all MIs with the primary and secondary MI definitions, respectively. Patients had an increased risk of all-cause death after type 1 MI (adjusted HR, 4.35 [95% CI, 2.73-6.93]) and after procedural MI with the primary (adjusted HR, 2.75 [95% CI, 0.99-7.60]) and secondary MI definitions (adjusted HR, 2.91 [95% CI, 1.73-4.88]). Dialysis initiation was increased after a type 1 MI (HR, 6.45 [95% CI, 2.59-16.08]) compared with patients without an MI. CONCLUSIONS In ISCHEMIA-CKD, the invasive treatment strategy had higher rates of procedural MIs, particularly with the secondary MI definition, and lower rates of type 1 and 2 MIs. Procedural MIs, type 1 MIs, and type 2 MIs were associated with increased risk of subsequent death. Type 1 MI increased the risk of dialysis initiation. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01985360.
Collapse
Affiliation(s)
| | - Derek D. Cyr
- Duke Clinical Research Institute and Duke University, Durham, NC, USA
| | | | - Radosław Pracoń
- Coronary and Structural Heart Diseases Department, Institute of Cardiology, Mazowieckie, Poland
| | - Kevin R. Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Anoop Mathew
- MOSC Medical College Hospital, Kolenchery, India
| | | | | | - Jerome L. Fleg
- National National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Renato D. Lopes
- Duke Clinical Research Institute and Duke University, Durham, NC, USA
| | | | | | - Frank W. Rockhold
- Duke Clinical Research Institute and Duke University, Durham, NC, USA
| | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA and the Cardiovascular Research Foundation, New York, NY, USA
| | - David J. Maron
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | |
Collapse
|
8
|
Ferro CJ, Berry M, Moody WE, George S, Sharif A, Townend JN. Screening for occult coronary artery disease in potential kidney transplant recipients: time for reappraisal? Clin Kidney J 2021; 14:2472-2482. [PMID: 34950460 PMCID: PMC8690093 DOI: 10.1093/ckj/sfab103] [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: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022] Open
Abstract
Screening for occult coronary artery disease in potential kidney transplant recipients has become entrenched in current medical practice as the standard of care and is supported by national and international clinical guidelines. However, there is increasing and robust evidence that such an approach is out-dated, scientifically and conceptually flawed, ineffective, potentially directly harmful, discriminates against ethnic minorities and patients from more deprived socioeconomic backgrounds, and unfairly denies many patients access to potentially lifesaving and life-enhancing transplantation. Herein we review the available evidence in the light of recently published randomized controlled trials and major observational studies. We propose ways of moving the field forward to the overall benefit of patients with advanced kidney disease.
Collapse
Affiliation(s)
- Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Miriam Berry
- Department of Renal Medicine, University Hospitals Birmingham, Birmingham, UK
| | - William E Moody
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Sudhakar George
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Adnan Sharif
- Department of Renal Medicine, University Hospitals Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| |
Collapse
|
9
|
Jankowski P, Topór-Mądry R, Gąsior M, Cegłowska U, Eysymontt Z, Gierlotka M, Wita K, Legutko J, Dudek D, Sierpiński R, Pinkas J, Kaźmierczak J, Witkowski A, Szumowski Ł. Innovative Managed Care May Be Related to Improved Prognosis for Acute Myocardial Infarction Survivors. Circ Cardiovasc Qual Outcomes 2021; 14:e007800. [PMID: 34380330 DOI: 10.1161/circoutcomes.120.007800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland. METHODS We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged <18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death from any cause. RESULTS The mean follow-up was 324.8±140.5 days (78 034.1 patient-years; 340.0±131.7 days in those who did not die during the observation). Participation in the managed care program was related to higher odds ratio of participating in cardiac rehabilitation (4.67 [95% CI, 4.44-4.88]), consultation with a cardiologist (7.32 [6.83-7.84]), implantable cardioverter-defibrillator (1.40 [1.22-1.61]), and cardiac resynchronization therapy with cardioverter-defibrillator implantation (1.57 [1.22-2.03]) but lower odds of emergency (0.88 [0.79-0.98]) and nonemergency percutaneous coronary intervention (0.88 [0.83-0.93]) and coronary artery bypass grafting (0.82 [0.71-0.94]) during the follow-up. One-year all-cause mortality was 4.4% among the program participants and 6.0% in matched nonparticipants. The end point consisting of all-cause death, myocardial infarction, or stroke occurred in 10.6% and 12.0% (P<0.01) of participants and nonparticipants respectively, whereas all-cause death or hospitalization for cardiovascular reasons in 42.2% and 47.9% (P<0.001) among participants and nonparticipants, respectively. The difference in outcomes between patients participating and not participating in the managed care program could be explained by improved access to cardiac rehabilitation, cardiac care, and cardiac procedures. CONCLUSIONS Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.
Collapse
Affiliation(s)
- Piotr Jankowski
- I Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (P.J.)
| | - Roman Topór-Mądry
- Agency for Health Technology Assessment and Tariff System, Warsaw, Poland (R.T.-M., U.C.)
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze (M. Gąsior), Medical University of Silesia, Katowice, Poland
| | - Urszula Cegłowska
- Agency for Health Technology Assessment and Tariff System, Warsaw, Poland (R.T.-M., U.C.)
| | - Zbigniew Eysymontt
- Cardiac Rehabilitation Department, Ślaskie Centrum Rehabilitacji w Ustroniu, Ustron, Poland (Z.E.)
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland (M. Gierlotka)
| | - Krystian Wita
- First Department of Cardiology, School of Medicine in Katowice (K.W.), Medical University of Silesia, Katowice, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland (J.L.)
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Kopernika 17, Krakow, Poland (D.D.)
| | | | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland (J.P.)
| | - Jarosław Kaźmierczak
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland (J.K.)
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (A.W.)
| | | |
Collapse
|
10
|
Prognosis of acute myocardial infarction in patients on hemodialysis stratified by Killip classification in the modern interventional era (focus on the prognosis of Killip class 1). Heart Vessels 2021; 37:208-218. [PMID: 34347137 DOI: 10.1007/s00380-021-01919-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/28/2021] [Indexed: 12/22/2022]
Abstract
Cardiovascular events and death are more prevalent in hemodialysis (HD) patients than in the general population. However, a detailed prognostic risk stratification of HD patients with acute myocardial infarction (AMI) has not yet been performed in the modern interventional era. We examined 4509 AMI patients (89 AMI/HD and 4420 AMI/non-HD) from the Mie ACS registry and detailed prognostic analyses based on the Killip classification were performed (Cohort A). In addition, prognosis of Killip class1 AMI/HD was compared with those of 313 non-AMI/HD patients from the MIE-CARE HD study using propensity score-matching method (Cohort B). Primary endpoint was all-cause mortality for up to 2 years. All-cause death occurred in 13.0% of AMI/non-HD and 35.8% of AMI/HD during follow-up, and patients with Killip class 1 had lower 30-day and 2-year mortality than those with Killip class ≥ 2 in both AMI/non-HD and AMI/HD. Cox regression analyses identified that Killip class ≥ 2 was the strongest independent prognostic factor of 30-day mortality with a hazard ratio of 7.44 (p < 0.001), whereas both presence of HD and Killip class ≥ 2 were the independent prognostic factors of mortality for up to 2 years. In Cohort B, a propensity score-matching analysis revealed similar all-cause mortality rates between Killip class 1 AMI/HD and non-AMI/HD. In HD patients with Killip class 1 AMI, 30-day mortality was around 6%, and long-term mortality among 30-day survivors after AMI was comparable with the natural course of HD patients in the modern interventional era. Clinical trial registration: URL: https://www.umin.ac.jp/ctr/index-j.htm . UMIN000036020 and UMIN000008128.
Collapse
|
11
|
Contemporary Status of Acute Myocardial Infarction in Korean Patients: Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers. J Clin Med 2021; 10:jcm10030498. [PMID: 33535380 PMCID: PMC7867023 DOI: 10.3390/jcm10030498] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study aimed to present the development process and characteristics of the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC). METHODS We developed KRAMI-RCC, a web-based registry for patients with AMI. Patients from 14 RCCs were registered for more than three years from July 2016. It includes an automatic error-checking system, and user training and on-site monitoring are performed to manage data quality. RESULTS A total of 11,700 AMI patients were registered in KRAMI-RCC over three years (73.9% men). The proportions of patients with ST-elevation and non-ST-elevation myocardial infarction at discharge were 43.4% and 56.6%, respectively. Of the total three-year patients, 5.6% died in the hospital, and 4.4% died 12 months after discharge. The case fatality within 12 months was 9.7%. Pre-hospital care data showed delayed arrival time after onset of symptoms (median 153 min) and low transportation rate by public ambulance (25.2%). Post-hospital care data showed lower participation rate in the second rehabilitation program (16.8%). CONCLUSIONS The recently developed KRAMI-RCC registry has been more focused on pre-hospital and post-hospital data, which will be helpful in understanding the current state of AMI disease management and in making policy decisions to reduce case fatality in Korea.
Collapse
|
12
|
Data from the ERA-EDTA Registry were examined for trends in excess mortality in European adults on kidney replacement therapy. Kidney Int 2020; 98:999-1008. [PMID: 32569654 DOI: 10.1016/j.kint.2020.05.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 01/18/2023]
Abstract
The objective of this study was to investigate whether the improvement in survival seen in patients on kidney replacement therapy reflects the enhanced survival of the general population. Patient and general population statistics were obtained from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry and the World Health Organization databases, respectively. Relative survival models were composed to examine trends over time in all-cause and cause-specific excess mortality, stratified by age and modality of kidney replacement therapy, and adjusted for sex, primary kidney disease and country. In total, 280,075 adult patients started kidney replacement therapy between 2002 and 2015. The excess mortality risk in these patients decreased by 16% per five years (relative excess mortality risk (RER) 0.84; 95% confidence interval 0.83-0.84). This reflected a 14% risk reduction in dialysis patients (RER 0.86; 0.85-0.86), and a 16% increase in kidney transplant recipients (RER 1.16; 1.07-1.26). Patients on dialysis showed a decrease in excess mortality risk of 28% per five years for atheromatous cardiovascular disease as the cause of death (RER 0.72; 0.70-0.74), 10% for non-atheromatous cardiovascular disease (RER 0.90; 0.88-0.92) and 10% for infections (RER 0.90; 0.87-0.92). Kidney transplant recipients showed stable excess mortality risks for most causes of death, although it did worsen in some subgroups. Thus, the increase in survival in patients on kidney replacement therapy is not only due to enhanced survival in the general population, but also due to improved survival in the patient population, primarily in dialysis patients.
Collapse
|
13
|
Burlacu A, Genovesi S, Basile C, Ortiz A, Mitra S, Kirmizis D, Kanbay M, Davenport A, van der Sande F, Covic A. Coronary artery disease in dialysis patients: evidence synthesis, controversies and proposed management strategies. J Nephrol 2020; 34:39-51. [PMID: 32472526 DOI: 10.1007/s40620-020-00758-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/23/2020] [Indexed: 12/31/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in this population. The incidence, severity and mortality of coronary artery disease (CAD) as well as the number of complications of its therapy is higher in dialysis patients than in non-chronic kidney disease patients. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. Furthermore, guidelines lack any recommendation for these patients or extrapolate them from trials performed in non-dialysis patients. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. This may lead to "therapeutic nihilism", which has been associated with worse outcomes. Here, the ERA-EDTA EUDIAL Working Group reviews the diagnostic work-up and therapy of chronic coronary syndromes, unstable angina/non-ST elevation and ST-elevation myocardial infarction in dialysis patients, outlining unclear issues and controversies, discussing recent evidence, and proposing management strategies. Indications of antiplatelet and anticoagulant therapies, percutaneous coronary intervention and coronary artery bypass grafting are discussed. The issue of the interaction between dialysis session and myocardial damage is also addressed.
Collapse
Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Simonetta Genovesi
- Nephrology Unit, San Gerardo Hospital, Monza, Italy, University of Milan-Bicocca, Milan, Italy
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Via Battisti 192, Acquaviva delle Fonti, 74121, Taranto, Italy. .,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Alberto Ortiz
- FRIAT and REDINREN, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals Foundation Trust and University of Manchester, Oxford Road, Manchester, UK
| | | | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Andrew Davenport
- Division of Medicine, UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Frank van der Sande
- Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center-'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania.,The Academy of Romanian Scientists (AOSR), Bucharest, Romania
| | | |
Collapse
|
14
|
Kassianides X, Hazara A, Bhandari S. Cardiac complications in end-stage renal disease: a shared care challenge. THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:10. [PMID: 35747081 PMCID: PMC8793925 DOI: 10.5837/bjc.2020.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Adil Hazara
- Specialty Trainee in Renal Medicine and Clinical Research Fellow Department of Academic Renal Medicine, Academic Renal Research, 2nd Floor Alderson House, Hull Royal Infirmary, Anlaby Road, Kingston upon Hull, HU3 2JZ
| | - Sunil Bhandari
- Consultant in Renal Medicine and Honorary Professor Department of Academic Renal Medicine, Academic Renal Research, 2nd Floor Alderson House, Hull Royal Infirmary, Anlaby Road, Kingston upon Hull, HU3 2JZ
| |
Collapse
|