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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6521600. [DOI: 10.1093/ejcts/ezac054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/10/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
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Pan E, Nielsen SJ, Mennander A, Björklund E, Martinsson A, Lindgren M, Hansson EC, Pivodic A, Jeppsson A. Statins for secondary prevention and major adverse events after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2021; 164:1875-1886.e4. [PMID: 34893327 DOI: 10.1016/j.jtcvs.2021.08.088] [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: 04/30/2021] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the association of statin use after coronary artery bypass grafting (CABG) and long-term adverse events in a large population-based, nationwide cohort. METHODS All 35,193 patients who underwent first-time isolated CABG in Sweden from 2006 to 2017 and survived at least 6 months after surgery were included. Individual patient data from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and 4 other nationwide registries were merged. Multivariable Cox regression models adjusted for age, sex, comorbidities, and time-updated treatment with other secondary preventive medications were used to evaluate the associations between statin treatment and outcomes. The primary end point was major adverse cardiovascular events (MACE). Median follow-up time to MACE was 5.3 (interquartile range, 2.5-8.2) years. RESULTS Statins were dispensed to 95.7% of the patients six months after discharge and to 78.9% after 10 years. At baseline, 1.4% of patients were prescribed low-, 57.6% intermediate-, and 36.7% high-dose statins. Ongoing statin treatment was associated with markedly reduced risk of MACE (adjusted hazard ratio [aHR], 0.56 [95% CI, 0.53-0.59]), all-cause mortality (aHR, 0.53 [95% CI, 0.50-0.56]), cardiovascular death (aHR, 0.54 [95% CI, 0.50-0.59]), myocardial infarction (aHR, 0.61 [95% CI, 0.55-0.69]), stroke (aHR, 0.66 [95% CI, 0.59-0.73]), new revascularization (aHR, 0.79 [95% CI, 0.70-0.88]), new angiography (aHR, 0.81 [95% CI, 0.74-0.88]), and dementia (aHR, 0.74 [95% CI, 0.65-0.85]; all P < .01), irrespective of the statin dose. CONCLUSIONS Ongoing statin use was associated with a markedly reduced incidence of adverse events and mortality after CABG. Initiating and maintaining statin medication is essential in CABG patients.
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Affiliation(s)
- Emily Pan
- Department of Surgery and Clinical Medicine, University of Turku, Turku, Finland; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ari Mennander
- Heart Center, Tampere University Hospital, and University of Tampere, Tampere, Finland
| | - Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Medicine, South Alvsborg Hospital, Borås, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Björklund E, Nielsen SJ, Hansson EC, Karlsson M, Wallinder A, Martinsson A, Tygesen H, Romlin BS, Malm CJ, Pivodic A, Jeppsson A. Secondary prevention medications after coronary artery bypass grafting and long-term survival: a population-based longitudinal study from the SWEDEHEART registry. Eur Heart J 2021; 41:1653-1661. [PMID: 31638654 PMCID: PMC7194184 DOI: 10.1093/eurheartj/ehz714] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/19/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
Aims To evaluate the long-term use of secondary prevention medications [statins, β-blockers, renin–angiotensin–aldosterone system (RAAS) inhibitors, and platelet inhibitors] after coronary artery bypass grafting (CABG) and the association between medication use and mortality. Methods and results All patients who underwent isolated CABG in Sweden from 2006 to 2015 and survived at least 6 months after discharge were included (n = 28 812). Individual patient data from SWEDEHEART and other mandatory nationwide registries were merged. Multivariable Cox regression models using time-updated data on dispensed prescriptions were used to assess associations between medication use and long-term mortality. Statins were dispensed to 93.9% of the patients 6 months after discharge and to 77.3% 8 years later. Corresponding figures for β-blockers were 91.0% and 76.4%, for RAAS inhibitors 72.9% and 65.9%, and for platelet inhibitors 93.0% and 79.8%. All medications were dispensed less often to patients ≥75 years. Treatment with statins [hazard ratio (HR) 0.56, 95% confidence interval (95% CI) 0.52–0.60], RAAS inhibitors (HR 0.78, 95% CI 0.73–0.84), and platelet inhibitors (HR 0.74, 95% CI 0.69–0.81) were individually associated with lower mortality risk after adjustment for age, gender, comorbidities, and use of other secondary preventive drugs (all P < 0.001). There was no association between β-blockers and mortality risk (HR 0.97, 95% CI 0.90–1.06; P = 0.54). Conclusion The use of secondary prevention medications after CABG was high early after surgery but decreased significantly over time. The results of this observational study, with inherent risk of selection bias, suggest that treatment with statins, RAAS inhibitors, and platelet inhibitors is essential after CABG whereas the routine use of β-blockers may be questioned. ![]()
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Affiliation(s)
- Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Medicine, South Älvsborg Hospital, Borås, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Karlsson
- Department of Medicine, Skaraborg Hospital Lidköping, Lidköping, Sweden
| | - Andreas Wallinder
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Tygesen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Medicine, South Älvsborg Hospital, Borås, Sweden
| | - Birgitta S Romlin
- Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Malm
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Nielsen SJ, Karlsson M, Björklund E, Martinsson A, Hansson EC, Malm CJ, Pivodic A, Jeppsson A. Socioeconomic Factors, Secondary Prevention Medication, and Long-Term Survival After Coronary Artery Bypass Grafting: A Population-Based Cohort Study From the SWEDEHEART Registry. J Am Heart Assoc 2020; 9:e015491. [PMID: 32114890 PMCID: PMC7335537 DOI: 10.1161/jaha.119.015491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long-term survival in CABG patients with a low income and short education. Methods and Results Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population-based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β-blockers, and RAAS inhibitors), socioeconomic factors, patient characteristics, comorbidity, and long-term mortaity were merged. All-cause mortality risk was estimated using multivariable Cox regression models adjusted for patient characteristics, baseline comorbidities, time-updated secondary prevention medications, and socioeconomic status. Long-term mortality was higher in patients with a low income and short education. Statins and platelet inhibitors were dispensed less often to patients with a low income, both at baseline and after 8 years. The decline in dispensing over time was steeper for low-income patients. Short education was not associated with reduced dispensing of any secondary prevention medication. Use of statins (adjusted hazard ratio=0.57 [95% CI, 0.53-0.61]), RAAS inhibitors (adjusted hazard ratio=0.78 [0.73-0.84]), and platelet inhibitors (adjusted hazard ratio=0.74 [0.68-0.80]) were associated with reduced long-term mortality irrespective of socioeconomic status. Conclusions Secondary prevention medications are dispensed less often after CABG to patients with low income. Underusage of secondary prevention medications after CABG is associated with increased mortality risk independently of income and extent of education.
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Affiliation(s)
- Susanne J Nielsen
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Martin Karlsson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Medicine Skaraborg Hospital Lidköping Lidköping Sweden
| | - Erik Björklund
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Medicine South Älvsborg Hospital Borås Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Carl Johan Malm
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen Gothenburg Sweden.,Department of Ophthalmology Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
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Association between Public Reporting of Outcomes and the Use of Mechanical Circulatory Support in Patients with Cardiogenic Shock. J Interv Cardiol 2019; 2019:3276521. [PMID: 31772523 PMCID: PMC6766255 DOI: 10.1155/2019/3276521] [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: 05/21/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022] Open
Abstract
Risk-averse behavior has been reported among physicians and facilities treating cardiogenic shock in states with public reporting. Our objective was to evaluate if public reporting leads to a lower use of mechanical circulatory support in cardiogenic shock. We conducted a retrospective study with the use of the National Inpatient Sample from 2005 to 2011. Hospitalizations of patients ≥18 years old with a diagnosis of cardiogenic shock were included. A regional comparison was performed to identify differences between reporting and nonreporting states. The main outcome of interest was the use of mechanical circulatory support. A total of 13043 hospitalizations for cardiogenic shock were identified of which 9664 occurred in reporting and 3379 in nonreporting states (age 69.9 ± 0.4 years, 56.8% men). Use of mechanical circulatory support was 32.8% in this high-risk population. Odds of receiving mechanical circulatory support were lower (OR 0.50; 95% CI 0.43-0.57; p < 0.01) and in-hospital mortality higher (OR 1.19; 95% CI 1.06-1.34; p < 0.01) in reporting states. Use of mechanical circulatory support was also lower in the subgroup of patients with acute myocardial infarction and cardiogenic shock in reporting states (OR 0.61; 95% CI 0.51-0.72; p < 0.01). In conclusion, patients with cardiogenic shock in reporting states are less likely to receive mechanical circulatory support than patients in nonreporting states.
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Safaie N, Entezari Maleki T, Alhasan Z, Hosseini N. Clopidogrel Adherence to AHA/ACC Guideline in Patients with Open Heart Surgery in a Tertiary Heart Center. PHARMACEUTICAL SCIENCES 2019. [DOI: 10.15171/ps.2019.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Clopidogrel is an antiplatelet drug that is widely prescribed for cardiovascular disease. In cardiac surgery, it is used in patients after coronary artery bypass grafting (CABG) to prevent coagulation disorders. The irrational use of this drug can lead to bleeding and require surgical exploration along with increased therapeutic cost. Therefore, it is essential to study the pattern of clopidogrel use in hospitals. Methods: This study was conducted for a 6-month period to evaluate clopidogrel adherence to American Heart Association/American College of Cardiology (AHA / ACC) Guidelines in patients after coronary artery bypass grafting (CABG) surgery. Patients’ data were recorded in the pre-designed questionnaire, which included demographic data, past medical history, drug history along with the indications of clopidogrel use. Data analysis was performed by SPSS 16 software. Results: A total of 120 patients with a mean age of 61.3 ± 8.9 years old were recruited in to this study. Male to female ratio was 3 times. The main risk factors in patients with ischemic heart disease were male gender (74.2%), hypertension (80%), and smoking (47.5%). In addition to clopidogrel, most of the patients received aspirin (95.8%), followed by heparin (31.7%), and warfarin (5%) or enoxaparin (2.5%). The clopidogrel indications were non ST-elevation myocardial infarction / unstable angina (33.3%), acute ST-elevation myocardial infarction (20.8%), recent myocardial infarction or stroke (3.3%), and CABG off-pump (30%). In 70.8% of cases, the administration of clopidogrel was consistent with AHA / ACC standard guidelines and most of the irrational cases belonged to the usage of the drug after on-pump CABG surgery. Conclusion: The results showed that the rates of adherence to clopidogrel use with the AHA/ACC guidelines for patients who underwent CABG surgery was relatively good, but required further improvement.
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Affiliation(s)
- Naser Safaie
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zainab Alhasan
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nafiseh Hosseini
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Ajrouche A, Estellat C, De Rycke Y, Tubach F. Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population. J Cardiovasc Pharmacol Ther 2019; 25:37-46. [PMID: 31339341 DOI: 10.1177/1074248419865287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have shown that adherence to low-dose aspirin (LDA) is suboptimal. However, these studies were based on an average measure of adherence during follow-up, ignoring its dynamic process over time. We described the trajectories of adherence to LDA treatment among the French population over 3 years of follow-up. METHODS We identified a cohort of 11 793 new LDA users, aged ≥50 years in 2010, by using the French national health-care database. Patients included had at least 3 years of history in the database before study entry to exclude prevalent aspirin users and to assess baseline comorbidities. They were followed from the first date of LDA supply (the index date) until the first date among death, exit from the database, or 3 years after the index date. Adherence to LDA was assessed every 3 months by using the proportion of days covered (PDC) and dichotomized with a cutoff of PDC of 0.8. We used group-based trajectory modeling to identify trajectories of LDA adherence. Predictors of LDA adherence trajectory membership were identified by multinomial logistics regression. RESULTS We identified 4 trajectories of adherence among new LDA users: the not-adherents (4737 [40.2%]), the delayed not-adherents (gradual decrease in adherence probability, 1601 [13.6%]), the delayed adherents (gradual increase in adherence probability, 1137 [9.6%]), and the persistent adherents (4318 [36.6%]). The probability of belonging to the not-adherent group was increased with female sex, low socioeconomic status, and polymedication and was reduced with a secondary indication for LDA use, such as diabetes, hypertension, and dementia, at least 4 consultations in the previous year, or 1 hospitalization or a cardiologist consultation in the 3 months before the index date. CONCLUSION This study provides a dynamic picture of adherence behaviors among new LDA users and underlines the presence of critical trajectories that intervention could target to improve adherence.
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Affiliation(s)
- Aya Ajrouche
- Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123, ECEVE, CIC-P 1421, Paris, France
| | - Candice Estellat
- Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123, ECEVE, CIC-P 1421, Paris, France
| | - Yann De Rycke
- Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123, ECEVE, CIC-P 1421, Paris, France
| | - Florence Tubach
- Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123, ECEVE, CIC-P 1421, Paris, France
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Cao RY, Zheng H, Mi Q, Li Q, Yuan W, Ding Y, Yang J. Aerobic exercise-based cardiac rehabilitation in Chinese patients with coronary heart disease: study protocol for a pilot randomized controlled trial. Trials 2018; 19:363. [PMID: 29986745 PMCID: PMC6038344 DOI: 10.1186/s13063-018-2771-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background Cardiovascular disease is the leading cause of morbidity and mortality in the world, including China. Cardiac rehabilitation (CR) has been demonstrated to be beneficial in reducing cardiovascular mortality, myocardial infarction, and cerebrovascular events. This pilot study seeks to assess the feasibility of aerobic-exercise-based CR in Chinese patients with coronary heart disease (CHD) and outcomes of aerobic metabolism capacity and molecular biomarkers. Methods/design This study is a single-center, pilot, randomized, controlled study that is currently being carried out at a regional hospital in Shanghai. Forty patients with CHD who underwent percutaneous coronary intervention will be randomly allocated into either the intervention group or control group. Participants in the intervention group will undergo 8 weeks of aerobic exercise with targeted intensity and participants in the control group will undergo 8 weeks of leisure exercise. The primary measurement is the feasibility of the trial; the secondary measurement is the capacity of aerobic metabolism and the exploratory measurement includes additional molecular biomarkers underlying cardiovascular function. Discussion This is the first prospective randomized and controlled clinical study in China that assesses the parameters of aerobic metabolism and comprehensively screens for substantial blood biomarkers to reveal the molecular mechanisms underlying changes in cardiovascular function after aerobic exercise with targeted intensity in participants with CHD. The success of this study will contribute to guide the design of future CR studies in patients with CHD in China. Trial registration Chinese Clinical Trial Registry, ChiCTR-IPR-17010556. Registered on 1 June 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2771-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard Y Cao
- The Joint Laboratory of Cardiac Rehabilitation, Shanghai Xuhui Central Hospital & Shanghai University, 966 Middle Huaihai Road, 200031 & 99 Shangda Road, Shanghai, 200444, China.
| | - Hongchao Zheng
- The Joint Laboratory of Cardiac Rehabilitation, Shanghai Xuhui Central Hospital & Shanghai University, 966 Middle Huaihai Road, 200031 & 99 Shangda Road, Shanghai, 200444, China
| | - Qiongyao Mi
- The Joint Laboratory of Cardiac Rehabilitation, Shanghai Xuhui Central Hospital & Shanghai University, 966 Middle Huaihai Road, 200031 & 99 Shangda Road, Shanghai, 200444, China
| | - Qing Li
- The Joint Laboratory of Cardiac Rehabilitation, Shanghai Xuhui Central Hospital & Shanghai University, 966 Middle Huaihai Road, 200031 & 99 Shangda Road, Shanghai, 200444, China
| | - Wenchao Yuan
- The Joint Laboratory of Cardiac Rehabilitation, Shanghai Xuhui Central Hospital & Shanghai University, 966 Middle Huaihai Road, 200031 & 99 Shangda Road, Shanghai, 200444, China
| | - Yueyou Ding
- The Joint Laboratory of Cardiac Rehabilitation, Shanghai Xuhui Central Hospital & Shanghai University, 966 Middle Huaihai Road, 200031 & 99 Shangda Road, Shanghai, 200444, China
| | - Jian Yang
- The Joint Laboratory of Cardiac Rehabilitation, Shanghai Xuhui Central Hospital & Shanghai University, 966 Middle Huaihai Road, 200031 & 99 Shangda Road, Shanghai, 200444, China.
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Gao XQ, Li Y, Jiang ZL. Comparison of Secondary Prevention Status between Percutaneous Coronary Intervention and Coronary Artery Bypass Patients. Arq Bras Cardiol 2017; 109:466-474. [PMID: 29267627 PMCID: PMC5729783 DOI: 10.5935/abc.20170153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Data are scarce regarding disparities in cardiovascular risk factor
management between patients treated with percutaneous coronary intervention
(PCI) and those treated with coronary artery bypass grafting (CABG). Objective Whether the goal achievement rates of cardiovascular risk factors were
different between PCI and CABG patients. Methods We retrospectively reviewed the data retrieved from a clinical record
database of patients admitted to Beijing Anzhen Hospital between January 1,
2014, and December 31, 2014, who underwent PCI or CABG. Results Compared with the CABG group, low-density lipoprotein cholesterol (LDL-C)
< 1.8 mmol/L (28.6% vs. 24.7%; p < 0.01), LDL-C < 2.07 mmol/L
(43.5% vs. 39.4%; p < 0.01) and blood pressure (BP) < 140/90 mm Hg
(85.6% vs. 77.7%; p < 0.01) goal achievement rates were significantly
higher in the PCI group. Compared with patients ≥ 60 years old:
patients < 60 years old had better BP < 140/90 mm Hg goal achievement
rates (87.7% vs. 84.4%; p < 0.01) in the PCI group, and better fasting
blood-glucose (FBG) < 7 mmol/L (79.4% vs.72.0%; p < 0.01) and HbA1c
< 7% (79.4% vs. 70.1%; p < 0.01) goal achievement rates in the CABG
group. Compared with females: males had better LDL-C < 2.07 mmol/L (24.7%
vs. 28.5%; p < 0.01), FBG < 7 mmol/L (71.8% vs.75.2%; p < 0.01) and
HbA1c < 7% (70.4% vs. 74.1%; p < 0.01) goal achievement rates in the
PCI group. Conclusion Patients in the PCI group were generally more likely than those in the CABG
group to achieve LDL-C < 1.8 mmol/L and BP goals. The control of
cardiovascular risk factors differed between patients ≥ 60 years old
and < 60 years old. Female patients were less likely to achieve LDL-C,
FBG and HbA1c goals.
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Affiliation(s)
- Xia-Qing Gao
- Beijing Anzhen Hospital - Capital Medical University, Beijing - China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing - China
| | - Yanfang Li
- Beijing Anzhen Hospital - Capital Medical University, Beijing - China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing - China
| | - Zhi-Li Jiang
- Beijing Anzhen Hospital - Capital Medical University, Beijing - China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing - China
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Beatty AL, Bradley SM, Maynard C, McCabe JM. Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, and Valve Surgery. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003364. [DOI: 10.1161/circoutcomes.116.003364] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/24/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Alexis L. Beatty
- From the VA Puget Sound Health Care System, Seattle, WA (A.L.B., C.M.); University of Washington, Seattle (A.L.B., C.M., J.M.M.); VA Eastern Colorado Health Care System, Denver, CO (S.M.B.); University of Colorado School of Medicine, Aurora (S.M.B.); and Clinical Outcomes Assessment Program, Seattle, WA (C.M.)
| | - Steven M. Bradley
- From the VA Puget Sound Health Care System, Seattle, WA (A.L.B., C.M.); University of Washington, Seattle (A.L.B., C.M., J.M.M.); VA Eastern Colorado Health Care System, Denver, CO (S.M.B.); University of Colorado School of Medicine, Aurora (S.M.B.); and Clinical Outcomes Assessment Program, Seattle, WA (C.M.)
| | - Charles Maynard
- From the VA Puget Sound Health Care System, Seattle, WA (A.L.B., C.M.); University of Washington, Seattle (A.L.B., C.M., J.M.M.); VA Eastern Colorado Health Care System, Denver, CO (S.M.B.); University of Colorado School of Medicine, Aurora (S.M.B.); and Clinical Outcomes Assessment Program, Seattle, WA (C.M.)
| | - James M. McCabe
- From the VA Puget Sound Health Care System, Seattle, WA (A.L.B., C.M.); University of Washington, Seattle (A.L.B., C.M., J.M.M.); VA Eastern Colorado Health Care System, Denver, CO (S.M.B.); University of Colorado School of Medicine, Aurora (S.M.B.); and Clinical Outcomes Assessment Program, Seattle, WA (C.M.)
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Riley RF, Don CW, Aldea GS, Mokadam NA, Probstfield J, Maynard C, Goss JR. Recent Trends in Adherence to Secondary Prevention Guidelines for Patients Undergoing Coronary Revascularization in Washington State: An Analysis of the Clinical Outcomes Assessment Program (COAP) Registry. J Am Heart Assoc 2012; 1:e002733. [PMID: 26600570 PMCID: PMC4942980 DOI: 10.1161/jaha.112.002733] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 06/15/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies indicated that patients undergoing coronary artery bypass graft (CABG) surgery are less likely to receive guideline-based secondary prevention therapy than are those undergoing percutaneous coronary intervention (PCI) after an acute myocardial infarction. We aimed to evaluate whether these differences have persisted after the implementation of public reporting of hospital metrics. METHODS AND RESULTS The Clinical Outcomes Assessment Program (COAP) database was analyzed retrospectively to evaluate adherence to secondary prevention guidelines at discharge in patients who underwent coronary revascularization after an acute ST-elevation myocardial infarction in Washington State. From 2004 to 2007, 9260 patients received PCI and 692 underwent CABG for this indication. Measures evaluated included prescription of aspirin, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, or lipid-lowering medications; cardiac rehabilitation referral; and smoking-cessation counseling. Composite adherence was lower for CABG than for PCI patients during the period studied (79.6% versus 89.7%, P<0.01). Compared to patients who underwent CABG, patients who underwent PCI were more likely to receive each of the pharmacological therapies. There was no statistical difference in smoking-cessation counseling (91.7% versus 90.3%, P=0.63), and CABG patients were more likely to receive referral for cardiac rehabilitation (70.9% versus 48.3%, P<0.01). Adherence rates improved over time among both groups, with no significant difference in composite adherence in 2006 (85.6% versus 87.6%, P=0.36). CONCLUSIONS Rates of guideline-based secondary prevention adherence in patients with ST-elevation myocardial infarction who underwent CABG surgery have been improving steadily in Washington State. The improvement possibly is associated with the implementation of public reporting of quality measures.
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Affiliation(s)
- Robert F. Riley
- Section on Cardiology Wake Forest University Health SciencesWinston‐SalemNC
| | | | | | | | | | | | - J. Richard Goss
- Division of General Internal Medicine Harborview Medical CenterSeattleWA
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