Hospital burden of coronary artery disease: Trends of myocardial infarction and/or percutaneous coronary interventions in France 2009-2014

Use of low-dose varenicline in hospitalized smokers: A case series low-dose varenicline in hospitalized smokers

Nicotine replacement therapy is the primary medication used to treat tobacco dependence in hospitalized patients. Recent evidence shows that varenicline is more effective than nicotine replacement, but varenicline side effects limit its use in the hospital. Low-dose varenicline has shown similar efficacy as standard dose, but has fewer side effects and thus may be useful in hospitalized patients. We assessed the effectiveness and tolerability of low-dose varenicline (1 mg each morning or 0.5 mg twice daily; patient choice) in hospitalized adult daily smokers between July 2022 and March 2023. The primary outcome was self-reported 7-day smoking abstinence at the first outpatient visit after hospitalization. Secondary outcomes included smoking reduction and medication tolerability. Of the 15 patients assessed, 8 (53.3%) reported 7-day smoking abstinence at their first post-discharge outpatient visit (mean of 14.9 days after discharge). Mean cigarettes per day decreased from 22.0 (SD 17.4) prior to hospitalization to 3.7 (SD 6.0) after hospitalization. Low-dose varenicline was well tolerated, with 80% (12) patients reporting no adverse events and 20% (3) patients reporting mild side effects not requiring a change in medication or dose. Study outcomes support the possibility that low-dose varenicline might be an effective and well-tolerated treatment for hospitalized smokers. Results from this case series are limited by the small sample size and lack of a control arm. Findings suggest that a randomized controlled trial may be warranted to assess the efficacy and tolerability of low-dose varenicline in hospitalized patients.

Coronary artery disease is associated with particular change of serum metabolome: a case-control study

INTRODUCTION

Cardiovascular disease (CVD) is a significant cause of mortality worldwide. Preventive programs are trying to reduce the burden of the disease. Recent advances in metabolomics profiling open a new avenue for developing complementary CVD evaluation strategies.

OBJECTIVES

The aim of the study was to investigate whether a metabolomic profile can provide an additional characterisation of individuals with coronary artery disease (CAD).

METHODS

The study included 167 participants with CAD aged 41-79 years. A control group was formed of 166 individuals without CAD, gender- and age-matched to the study group. A total of 188 metabolites were profiled in serum by liquid chromatography-tandem mass spectrometry. After clearing the data, associations between 132 metabolites and CAD presence were analysed using multiple linear regression models.

RESULTS

We observed significant differences in serum metabolic profiles between analysed groups on various levels. However, a deeper analysis revealed sphingomyelin 41:1 (SM 41:1) as the main metabolite independently associated with CAD after correction for classical CV risk factors. Its concentration was lower in the CAD group (median 9.79 µmol/L, interquartile range (IQR) 7.92-12.23) compared to control one (median 13.60 µmol/L, IQR 11.30-16.15) (p < 0.001). Further analysis showed that SM 41:1 concentration was inversely correlated with CAD, current smoking, and hypertension; and positively associated with female gender and non-HDL level.

CONCLUSIONS

CAD patients present lower plasma concentrations of SM 41:1 than healthy subjects. A better understanding of the biological function of sphingomyelin in CAD patients may help develop therapeutic approaches and risk stratification in this group.

Psychosocial adjustment changes and related factors in young and middle-aged patients with first-episode acute myocardial infarction: a longitudinal study

AIMS

This study aimed to explore the change trend and group heterogeneity of psychosocial adjustment level and to determine its influencing factors among young and middle-aged patients with first-episode acute myocardial infarction (AMI).

METHODS AND RESULTS

The Psychosocial Adjustment Scale of Illness was used to assess the psychosocial adjustment level of the patients at 1, 3, and 6 months after discharge, respectively. Data were analysed using Pearson correlation analysis, generalized estimating equations, and growth mixed models. A total of 233 patients were included, and their psychosocial adjustment scores at the three time points were 57.18 ± 15.50, 36.17 ± 15.02, and 24.22 ± 12.98, respectively. The trajectories of changes in patients' psychosocial adjustment levels were divided into three latent categories: moderate adjustment improvement group (72.5%), low adjustment improvement group (16.3%), and persistent maladjustment group (11.2%). Among them, predictors of the persistent maladjustment group included no spouse, low monthly family income per capita, normal body mass index, never smoking, never exercising, combined with hyperlipidaemia, low social support, submission coping, and high perceived stress.

CONCLUSION

The psychosocial adjustment level of young and middle-aged patients with first-episode AMI showed an upward trend within 6 months after discharge, and there was group heterogeneity in the change trajectory of psychosocial adjustment level. It is suggested that a multicentre, large-sample longitudinal study should be carried out in the future, and the time of follow-up investigation should be extended to further clarify the change trajectory and influencing factors of psychosocial adjustment of patients with different subtypes, to provide the theoretical basis for formulating targeted intervention programmes.

Genetically personalised organ-specific metabolic models in health and disease

Understanding how genetic variants influence disease risk and complex traits (variant-to-function) is one of the major challenges in human genetics. Here we present a model-driven framework to leverage human genome-scale metabolic networks to define how genetic variants affect biochemical reaction fluxes across major human tissues, including skeletal muscle, adipose, liver, brain and heart. As proof of concept, we build personalised organ-specific metabolic flux models for 524,615 individuals of the INTERVAL and UK Biobank cohorts and perform a fluxome-wide association study (FWAS) to identify 4312 associations between personalised flux values and the concentration of metabolites in blood. Furthermore, we apply FWAS to identify 92 metabolic fluxes associated with the risk of developing coronary artery disease, many of which are linked to processes previously described to play in role in the disease. Our work demonstrates that genetically personalised metabolic models can elucidate the downstream effects of genetic variants on biochemical reactions involved in common human diseases.

Trends in diabetes-related complications in Singapore, 2013-2020: A registry-based study

Background

Diabetes mellitus (DM) is a growing global health problem. In Singapore, the prevalence of Type 2 DM is rising, but comprehensive information about trends in DM-related complications is lacking.

Objectives

We utilized the Singapore Health Services (SingHealth) diabetes registry (SDR) to assess trends in DM micro and macro-vascular complications at the population level, explore factors influencing these trends.

Methods

We studied trends for ten DM-related complications: ischemic heart disease (IHD), acute myocardial infarction (AMI), peripheral arterial disease (PAD) and strokes, diabetic eye complications, nephropathy, neuropathy, diabetic foot, major and minor lower extremity amputation (LEA). The complications were determined through clinical coding in hospital (inpatient and outpatient) and primary care settings within the SingHealth cluster. We described event rates for the complications in 4 age-bands. Joinpoint regression was used to identify significant changes in trends.

Results

Among 222,705 patients studied between 2013 and 2020. 48.6% were female, 70.7% Chinese, 14.7% Malay and 10.6% Indian with a mean (SD) age varying between 64.6 (12.5) years in 2013 and 65.7 (13.2) years in 2020. We observed an increase in event rates in IHD, PAD, stroke, diabetic eye complications nephropathy, and neuropathy. Joinpoints was observed for IHD and PAD between 2016 to 2018, with subsequent plateauing of event rates. Major and minor LEA event rates decreased through the study period.

Conclusion

We found that DM and its complications represent an important challenge for healthcare in Singapore. Improvements in the trends of DM macrovascular complications were observed. However, trends in DM microvascular complications remain a cause for concern.

Differential Patterns and Outcomes of 20.6 Million Cardiovascular Emergency Department Encounters for Men and Women in the United States

Background We describe sex-differential disease patterns and outcomes of >20.6 million cardiovascular emergency department encounters in the United States. Methods and Results We analyzed primary cardiovascular encounters from the Nationwide Emergency Department Sample between 2016 and 2018. We grouped cardiovascular diagnoses into 15 disease categories. The sample included 48.7% women; median age was 67 (interquartile range, 54-78) years. Men had greater overall baseline comorbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common emergency department encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%), and acute myocardial infarction (10.7%). Women were more likely to present with essential hypertension, hypertensive crisis, atrial fibrillation/flutter, supraventricular tachycardia, pulmonary embolism, or ischemic stroke. Men were more likely to present with acute myocardial infarction or cardiac arrest. In logistic regression models adjusted for baseline covariates, compared with men, women with intracranial hemorrhage had higher risk of hospitalization and death. Women presenting with pulmonary embolism or deep vein thrombosis were less likely to be hospitalized. Women with aortic aneurysm/dissection had higher odds of hospitalization and death. Men were more likely to die following presentations with hypertensive heart or kidney disease, atrial fibrillation/flutter, acute myocardial infarction, or cardiac arrest. Conclusions In this large nationally representative sample of cardiovascular emergency department presentations, we demonstrate significant sex differences in disease distribution, hospitalization, and death.

Burden of ischemic heart disease in Spain: incidence, hospital mortality and costs of hospital care

BACKGROUND

Ischemic heart disease (IHD) is the leading global cause of death and is assumed to entail a significant social and economic burden globally. This study aimed to evaluate incidence and mortality trends of IHD in Spain and to estimate direct medical costs.

METHODS

Admission files corresponding to patients with IHD registered between 2011 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective study.

RESULTS

Admission data corresponding to 814,740 patients with IHD was analyzed. The majority of patients were males, and about half of the hospitalizations were due to an acute myocardial infarction. Incidence decreased significantly in most age groups over time, while hospital mortality rate remained stable (4.4%). Additionally, mortality rate was significantly higher among females (6.6%). Median admission cost was €5175; the higher costs per admission were found in patients with an acute myocardial infarction and in admissions with an ICU stay. The annual cost of hospital care was €693.8 million.

CONCLUSIONS

Despite the decreasing trends described in the general population, hospital mortality rate was constant among hospitalized patients during the study period. The higher hospital mortality rate described among females should be considered in further studies and protocol revisions.

Greater Nursing Role for Enhanced Post-Percutaneous Coronary Intervention Management

Percutaneous coronary intervention (PCI) has increasingly been used in management of coronary artery diseases (CAD). Coupled that with an increasing incidence rate of CAD has augmented the hospital burden with consequential post-PCI patient management problems and dissatisfaction. Nursing care has a key role to play in upgrading the healthcare services and raising patients’ satisfaction through enhanced patient education and engagement. In this regard, nursing-led intervention has shown some success in three main domains: risk reduction; psychological improvement; and quality of life. Urgent efforts are needed to formulize a structured follow-up with enhanced nursing role in post-PCI management to raise quality of healthcare.

Hospital healthcare flows: A longitudinal clustering approach of acute coronary syndrome in women over 45 years

Acute coronary syndrome (ACS) in women is a growing public health issue and a death leading cause. We explored whether the hospital healthcare trajectory was characterizable using a longitudinal clustering approach in women with ACS. From the 2009-2014 French nationwide hospital database, we extracted spatio-temporal patterns in ACS patient trajectories, by replacing the spatiality by their hospitalization cause. We used these patterns to characterize hospital healthcare flows in a visualization tool. We clustered these trajectories with kmlShape to identify time gap and tariff profiles. ACS hospital healthcare flows have three key categories: Angina pectoris, Myocardial Infarction or Ischemia. Elderly flows were more complex. Time gap profiles showed that readmissions were closer together as time goes by. Tariff profiles were different according to age and initial event. Our approach might be applied to monitoring other chronic diseases. Further work is needed to integrate these results into a medical decision-making tool.

Sequential Pattern Mining to Predict Medical In-Hospital Mortality from Administrative Data: Application to Acute Coronary Syndrome

Prediction of a medical outcome based on a trajectory of care has generated a lot of interest in medical research. In sequence prediction modeling, models based on machine learning (ML) techniques have proven their efficiency compared to other models. In addition, reducing model complexity is a challenge. Solutions have been proposed by introducing pattern mining techniques. Based on these results, we developed a new method to extract sets of relevant event sequences for medical events' prediction, applied to predict the risk of in-hospital mortality in acute coronary syndrome (ACS). From the French Hospital Discharge Database, we mined sequential patterns. They were further integrated into several predictive models using a text string distance to measure the similarity between patients' patterns of care. We computed combinations of similarity measurements and ML models commonly used. A Support Vector Machine model coupled with edit-based distance appeared as the most effective model. We obtained good results in terms of discrimination with the receiver operating characteristic curve scores ranging from 0.71 to 0.99 with a good overall accuracy. We demonstrated the interest of sequential patterns for event prediction. This could be a first step to a decision-support tool for the prevention of in-hospital death by ACS.

National Trends of Tobacco, Alcohol, and Drug Use in Patients Admitted With Acute Myocardial Infarction

BACKGROUND

Acute myocardial infarction (AMI) is a significant health and economic burden in the US. Tobacco, alcohol, and drug use are established risk factors. We sought to evaluate the national trend of use of each substance in patients admitted with AMI.

METHODS

We used the National Inpatient Sample between 2005 and 2017. We included adult patients hospitalized with AMI. International Classification of Diseases, Ninth and Tenth Revisions codes were used to define tobacco, alcohol, cocaine, opioid, cannabis and other drug use. Trends of each substance use were assessed using multivariable Poisson regression, and were expressed as annual percent change (APC) with their 95% confidence intervals (CIs).

RESULTS

A total of 10,796,844 hospitalizations with AMI were included. Among all substances used, tobacco was the most common (32.7%), followed by alcohol (3.2%). Between 2005 and 2017, the prevalence ratio of tobacco use increased from 21.5% to 44.5% with an APC +6.2% (95%CI 6.2%-6.2%). Tobacco users had more percutaneous coronary intervention (41%vs25%) and coronary artery bypass surgery (6.9%vs4.9%), p < 0.001. Further, there were positive trends in alcohol (APC +3.1%; 95%CI 3.0%-3.2%), opioid (APC +9.0%; 95%CI 8.7%-9.2%), cannabis (APC + 7.2; 95% CI 7%-7.4%), and combined all drug use (+7.1%; 95%CI 7%-7.2%). Meanwhile, there was a slight negative trend in cocaine use.

CONCLUSIONS

This analysis outlines the national trends of substance use in patients admitted with AMI and reveals an increasing prevalence of tobacco use, alcohol and drug use. More effective cessation measures are necessary to reduce the risk for AMI and its burden on the healthcare system and economy.

Modulation of the Expression of Long Non-Coding RNAs H19, GAS5, and MIAT by Endurance Exercise in the Hearts of Rats with Myocardial Infarction

Long non-coding RNAs (lncRNAs) have a critical role in the regulation of cardiovascular function. Dysregulation of lncRNAs is implicated in the progression of cardiovascular diseases including myocardial infarction (MI). Regarding the beneficial effects of exercise (Ex) on the improvement of MI, this study aimed to investigate the effects of post-MI Ex on the expression of MI-associated lncRNAs: H19, myocardial infarction association transcript (MIAT), and growth arrest specific 5 (GAS5). MI was induced by left anterior descending (LAD) coronary artery ligation in male Wistar rats. One week later, rats were exercised under a moderate-intensity protocol for 4 weeks. In the end, hemodynamic parameters and cardiac function indices were measured. Assessment of fibrotic areas and apoptosis was performed by Masson's trichrome staining and immunohistochemistry, respectively. Expression of genes was evaluated by real-time PCR. Ex significantly reduced the fibrotic areas (P < 0.05) and apoptosis and increased contractility indices (P < 0.01), and cardiac function (P < 0.05) in MI groups. The reduced expression of H19 (P < 0.01) in MI rats returned to normal levels by Ex. Ex significantly (P < 0.001) reduced the expression of MIAT and increased the expression of GAS5 (P < 0.01), which had changed in the hearts of rats with MI. The present study indicated the beneficial effect of Ex on the improvement of cardiac function and reduction of fibrosis in infarcted heart possibly through regulation of the expression of lncRNAs: H19, GAS5, and MIAT.

Information Needs in Percutaneous Coronary Artery Intervention: Validation and Reliability Analysis of NPCI-10 Item Scale

Introduction: Percutaneous coronary intervention (PCI) is a nonsurgical procedure used in the treatment of coronary heart disease.

Purpose: The purpose of this study was to validate a scale created in order to assess the importance and fulfillment of information needs in patients after PCI.

Methods: A 10-item scale was created by the researchers to explore the level of information needs and the level of fulfillment of these needs. The total scores have a possible range of 10 to 40 with higher scores indicating higher importance and fulfillment. The validation of the questionnaire included face and content validity, construct validity, internal consistency, repeatability, and discriminant validity.

Results: Forty patients contributed to this validation. Mean and median scores for each question separately and also overall scores suggest that patients consider the need to be informed very important and that it was fulfilled to a very high degree (mean scores 39.5 and 39.3, respectively). All questions were found to be significantly correlated with the overall scores (rho > 0.3) meaning strong construct validity. Cronbach’s α coefficients were high (>0.7) indicating great consistency. Both total scores had great repeatability, which suggests a high degree of reliability of the participants' responses (ICCs > 0.8). Regarding discriminant validity, a statistically significant association was observed only between marital status and the degree of fulfillment of the need to be informed (p = 0.036). More specifically, divorced or widowed patients had a lower degree of fulfillment than married patients (mean 38.6 vs. 39.6).

Conclusion: It is a reliable instrument that will help clinicians who are at close contact with patients after PCI to gain a better understanding of their needs.

The quest of cell surface markers for stem cell therapy

Stem cells and their derivatives are novel pharmaceutics that have the potential for use as tissue replacement therapies. However, the heterogeneous characteristics of stem cell cultures have hindered their biomedical applications. In theory and practice, when cell type-specific or stage-specific cell surface proteins are targeted by unique antibodies, they become highly efficient in detecting and isolating specific cell populations. There is a growing demand to identify reliable and actionable cell surface markers that facilitate purification of particular cell types at specific developmental stages for use in research and clinical applications. The identification of these markers as very important members of plasma membrane proteins, ion channels, transporters, and signaling molecules has directly benefited from proteomics and tools for proteomics-derived data analyses. Here, we review the methodologies that have played a role in the discovery of cell surface markers and introduce cutting edge single cell proteomics as an advanced tool. We also discuss currently available specific cell surface markers for stem cells and their lineages, with emphasis on the nervous system, heart, pancreas, and liver. The remaining gaps that pertain to the discovery of these markers and how single cell proteomics and identification of surface markers associated with the progenitor stages of certain terminally differentiated cells may pave the way for their use in regenerative medicine are also discussed.

Readiness for Voice Technology in Patients With Cardiovascular Diseases: Cross-Sectional Study

Background

The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients’ readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD).

Objective

This paper aims to evaluate patients’ anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone.

Methods

A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology.

Results

In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively).

Conclusions

Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology.

Post percutaneous coronary interventional outcomes on proximal vs non-proximal lesions of the left and right coronary arteries: A systematic review and meta-analysis

BACKGROUND

The prognosis of patients with coronary artery disease is mainly related to the extent of myocardium at risk. Proximal coronary arteries, especially the proximal left anterior descending coronary artery (LAD), supply a large part of the myocardium. In this analysis, we aimed to systematically compare the post percutaneous coronary interventional (PCI) outcomes observed with proximal vs non-proximal lesions of the left and right coronary arteries.

METHODS

MEDLARS Online, Excerpta Medica database, www.ClinicalTrials.gov, and the Cochrane databases were searched for relevant studies comparing the post PCI outcomes reported on proximal vs non-proximal lesions of the coronary arteries. RevMan software version 5.3 was used to analyze the data to generate respective results. Odds ratios (OR) and 95% confidence intervals (CI) were derived to represent the results appropriately.

RESULTS

Six studies with a total number of 11,109 participants who were enrolled between 1990 and 2015 were included in this analysis. The current results showed major adverse cardiac events (MACEs) (OR: 1.28, 95% CI: 1.14-1.45; P = .0001) and mortality (OR: 1.70, 95% CI: 1.43-2.03; P = .00001) to be significantly higher with proximal compared to non-proximal coronary lesions irrespective of the follow-up time periods. However, re-infarction (OR: 1.05, 95% CI: 0.80-1.38; P = .71), repeated revascularization (OR: 1.08, 95% CI: 0.92-1.27; P = .35) and stent thrombosis (OR: 0.59, 95% CI: 0.27-1.31; P = .20) were not significantly different.When patients specifically with LAD lesions were compared with associated non-proximal lesions, mortality was still significantly higher with proximal lesions (OR: 2.26, 95% CI: 1.52-3.36; P = .0001). However, when patients with right proximal coronary artery lesions were compared with the corresponding non-proximal lesions, no significant difference was observed in mortality.

CONCLUSION

In-hospital and long-term MACEs and mortality were significantly higher in patients with proximal compared to non-proximal coronary lesions following PCI. In addition, mortality was significantly higher in patients with proximal LAD lesions whereas no significant difference was observed in patients with right proximal coronary artery lesions. Larger trials should further confirm these hypotheses.