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Landolfo M, Spannella F, Gezzi A, Giulietti F, Sabbatini L, Bari I, Alessandroni R, Di Agostini A, Turri P, Alborino F, Scoppolini Massini L, Sarzani R. Validation of the Novel Web-Based Application HUMTELEMED for a Comprehensive Assessment of Cardiovascular Risk Based on the 2021 European Society of Cardiology Guidelines. J Clin Med 2024; 13:2295. [PMID: 38673568 PMCID: PMC11050958 DOI: 10.3390/jcm13082295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Background and aims: SCORE2/SCORE2-OP cardiovascular risk (CVR) charts and online calculators do not apply to patients with comorbidities, target organ damage, or atherosclerotic cardiovascular disease, for whom the assessment relies on the conventional consultation of the 2021 ESC guidelines (qualitative approach). To simplify the CVR evaluation, we developed an integrated multi-language and free-to-use web application. This study assessed the agreement between the conventional method versus our web app. Methods: A cross-sectional study was carried out on 1306 consecutive patients aged 40+ years referred to our center for the diagnosis and management of hypertension and dyslipidemia. Two double-blind operators performed the CVR assessment and classified each patient into low-moderate-, high-, and very-high-risk categories by using the conventional method (SCORE2/SCORE2-OP charts and consultation of the 2021 ESC guidelines) and the web app. The Kappa statistics were used to compare the two methods. Results: The mean age was 60.3 ± 11.9 years, with male prevalence (51.4%). Patients in primary prevention were 77.0%. According to the SCORE2/SCORE2-OP charts and 2021 ESC guideline consultation, the CVR was low-moderate in 18.6% (n° 243), high in 36.8% (n° 480), and very high in 44.6% (n° 583). According to the web app, individual CVR was low-moderate in 19.5% (n° 255), high in 35.4% (n° 462), and very high in 45.1% (n° 589). The two methods strongly agreed (Kappa = 0.960, p < 0.001), with a 97.5% concordance. Conclusions: our application has excellent reliability in a broad "real life" population and may help non-expert users and busy clinicians to assess individual CVR appropriately, representing a free-to-use, simple, time-sparing and widely available alternative to the conventional CVR evaluation using SCORE2/SCORE2-OP and 2021 ESC guideline charts.
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Affiliation(s)
- Matteo Landolfo
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | - Alessandro Gezzi
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
| | - Lucia Sabbatini
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | - Isabella Bari
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | - Romina Alessandroni
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | - Angelica Di Agostini
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | - Paolo Turri
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
| | | | | | - Riccardo Sarzani
- Internal Medicine and Geriatrics, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale di Ricovero e Cura per gli Anziani (INRCA), 60127 Ancona, Italy; (M.L.); (A.G.); (F.G.); (L.S.); (I.B.); (R.A.); (A.D.A.); (P.T.); (R.S.)
- Department of Clinical and Molecular Sciences (DISCLIMO), Centre of Obesity, University “Politecnica delle Marche”, 60127 Ancona, Italy
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van Trier TJ, Jørstad HT, Scholte Op Reimer WJM, Sunamura M, Ter Hoeve N, Aernout Somsen G, Peters RJG, Snaterse M. Patients' preferences for secondary prevention following a coronary event. Prev Med Rep 2024; 40:102681. [PMID: 38495768 PMCID: PMC10940170 DOI: 10.1016/j.pmedr.2024.102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Objective Despite clear evidence on the effectiveness of secondary prevention, patients with coronary artery disease frequently fail to reach guideline-based risk factor targets. Integrating patients' preferences into treatment decisions has been recommended to reduce this gap. However, this requires knowledge about patient treatment preferences. Therefore, through a survey study, we aimed to explore which risk factors patients self-perceived, prioritised for improvement, and needed support with after a recent hospitalisation for coronary heart disease. Methods A digital questionnaire was presented to patients > 18 years recently discharged (≤3 months) from an acute coronary care unit in the Netherlands (Europe). Patients could select from eight cardiovascular risk factors that they (1) self-perceived, (2) prioritised for improvement, and (3) needed support to improve. Patients' perceived risk factors were compared to those documented in the medical records. Results Respondents (N = 254, 26 % women), mean age 64 (SD 10) years, identified 'physical inactivity' more frequently than their medical records (140 patients vs. 91 records, p < 0.001), while three other risk factors were reported with equal and four with lower frequency. 'Physical inactivity', 'overweight' and 'stress' were most frequently prioritised for improvement (82 %, 88 % and 78 %) and professional support (64 %, 50 % and 58 %), with 87 % preferring lifestyle optimisation if this would reduce drug use. Conclusions Patients with a recent coronary event show significant disparities in identifying risk factors compared to their medical records. They tend to prefer improving lifestyle- over drug-modifiable risk factors, particularly physical inactivity, overweight and stress, and indicate the need for support in improving these factors.
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Affiliation(s)
- Tinka J van Trier
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Madoka Sunamura
- Capri Cardiac Rehabilitation Rotterdam, Rotterdam, The Netherlands
- Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC Medical Center, Rotterdam, The Netherlands
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Snaterse
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Castelijns MC, Hageman SHJ, Teraa M, van der Meer MG, Westerink J, Ten Berg J, Visseren FLJ. Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease. Heart 2024; 110:482-490. [PMID: 38182277 DOI: 10.1136/heartjnl-2023-323519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE Assessment of generalisability of guideline-informing trials on antithrombotic treatment intensification to real-world patients with cardiovascular disease (CVD). METHODS Inclusion and exclusion criteria of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA), Prevention of Cardiovascular events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction (PEGASUS-TIMI) and Dual Antiplatelet Therapy (DAPT) study were applied to coronary artery disease (CAD) and/or peripheral artery disease (PAD) patients from Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) to determine real-world eligibility. Eligible and ineligible patients were compared on baseline characteristics, cardiovascular events, major bleeding and mortality. RESULTS Eligibility ranged from 11%-94% for CAD to 75%-90% for patients with PAD. Cardiovascular, bleeding and mortality risks were higher in COMPASS-eligible patients with CAD (rate ratios (RR) 1.98 (95% CI 1.74 to 2.26), 2.02 (95% CI 1.47 to 2.78) and 3.11 (95% CI 2.71 to 3.57), respectively) and CHARISMA-eligible patients (RR 1.51 (95% CI 1.12 to 2.06), 2.25 (95% CI 1.01 to 6.21) and 4.43 (95% CI 2.79 to 7.51), respectively), and lower in COMPASS-eligible patients with PAD (RR 0.45 (95% CI 0.36 to 0.56), 0.29 (95% CI 0.18 to 0.46) and 0.45 (95% CI 0.38 to 0.54), respectively) and DAPT-eligible patients with CAD (RR CVD 0.49 (95% CI 0.34 to 0.69) and mortality 0.67 (95% CI 0.48 to 0.94)) than ineligible patients. After adjustment for trial eligibility criteria, only higher cardiovascular and mortality risks in COMPASS-eligible patients with CAD and lower cardiovascular risks in CHARISMA-eligible and DAPT-eligible patients persisted with CAD. CONCLUSION A large proportion of contemporary CVD patients would be eligible for intensified antithrombotic treatment trials, with mostly similar adjusted event risks to ineligible patients. Trial-based guideline recommendations are largely applicable to real-world patients.
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Affiliation(s)
- Maria C Castelijns
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Isala Clinics Zwolle, Zwolle, The Netherlands
| | - Jurrien Ten Berg
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Tamargo J, Agewall S, Borghi C, Ceconi C, Cerbai E, Dan GA, Ferdinandy P, Grove EL, Rocca B, Magavern E, Sulzgruber P, Semb AG, Sossalla S, Niessner A, Kaski JC, Dobrev D. New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2023. Eur Heart J Cardiovasc Pharmacother 2024:pvae013. [PMID: 38379024 DOI: 10.1093/ehjcvp/pvae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Although cardiovascular diseases are the leading cause of death worldwide, their pharmacotherapy remains suboptimal. Thus, there is a clear unmet need to develop more effective and safer pharmacological strategies. In this review, we summarize the most relevant advances in cardiovascular pharmacology in 2023, including the approval of first-in-class drugs that open new avenues for the treatment of atherosclerotic cardiovascular disease and heart failure. The new indications of drugs already marketed (repurposing) for the treatment of obstructive hypertrophic cardiomyopathy, hypercholesterolemia, type 2 diabetes, obesity and heart failure, the impact of polypharmacy on guideline-directed drug use is highlighted as well as results from negative clinical trials. Finally, we end with a summary of the most important phase 2 and 3 clinical trials assessing the efficacy and safety of cardiovascular drugs under development for the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto De Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Stefan Agewall
- Institute of Clinical Science, Oslo University, Oslo, Norvay
- Institute of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm Sweden
| | - Claudio Borghi
- Department of Cardiovascular Medicine, University of Bologna-IRCCS AOU S. Orsola, Bologna, Italy
| | - Claudio Ceconi
- Unit of Cardiologia, ASST Garda, Desenzano del Garda, Italy
| | - Elisabetta Cerbai
- Department Neurofarba, Section of Pharmacology and Toxicology, University of Florence, Italy
| | - Gheorghe A Dan
- Carol Davila. University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Bianca Rocca
- Department Neurofarba, Section of Pharmacology and Toxicology, University of Florence, Italy
- Section of Pharmacology, Department of Safety and Bioethics, Catholic University School of Medicine, Rome, Italy
| | - Emma Magavern
- William Harvey Research Institute, Centre of Clinical Pharmacology and Precision Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patrick Sulzgruber
- Department of Medicine, Division of Cardiology, Medical University of Vienna, Austria
| | - Anne Grete Semb
- Preventive Cario-Rheuma clinic, Division of Research and Innovation, REMEDY centre, Diakonhjemmet Hospital, Oslo, Norway
| | - Samuel Sossalla
- Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University, Giessen and Department of Cardiology, Kerckhoff-Clinic/DZHK, Bad Nauheim, Germany
- Abt. Kardiologie, Campus Kerckhoff der Justus-Liebig-Universität Gießen, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Dobromir Dobrev
- Institute of Pharmacology, West-German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
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Brouwers RWM, Scherrenberg M, Kemps HMC, Dendale P, Snoek JA. Cardiac telerehabilitation: current status and future perspectives. Neth Heart J 2024; 32:31-37. [PMID: 38085505 PMCID: PMC10781917 DOI: 10.1007/s12471-023-01833-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 01/04/2024] Open
Abstract
Multidisciplinary cardiac rehabilitation (CR) improves the prognosis and quality of life of patients with cardiovascular disease and has therefore received strong recommendations in international guidelines for the treatment of patients with chronic coronary syndromes and chronic heart failure. Aiming to both resolve several barriers that impede participation in CR and to improve the effectiveness of CR, cardiac telerehabilitation (CTR) has emerged as a cost-effective alternative to traditional, centre-based CR. Although the body of evidence for the feasibility and effectiveness of CTR is large and still growing, real-life implementations are scarce, which may be due to insufficient knowledge about CTR interventions and due to the challenges its implementation comes with. Up to now, mainly exercise-related core components of CR and e‑coaching have been investigated in the setting of CTR. Translation of research findings to clinical practice may be hampered by methodological limitations present in most CTR studies, being selection bias of participants, lack of long-term follow-up, heterogeneity of studied interventions and the lack of robust outcome measures. Besides conducting highly needed implementation studies for CTR interventions, their implementation could be facilitated by the development of guideline-based, multidisciplinary and personalised CTR programmes and widespread reimbursement for CTR.
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Affiliation(s)
- Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands.
- Heart Centre, Catharina Hospital, Eindhoven, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Johan A Snoek
- Isala Heart Centre, Zwolle, The Netherlands
- Sports Medicine Department, Isala, Zwolle, The Netherlands
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van Trier TJ, Snaterse M, Herings RMC, Overbeek JA, Peters RJG, Jørstad HT. Impact of implementing Dutch versus European guideline risk factor targets in older patients with ischaemic heart disease. Neth Heart J 2024; 32:45-54. [PMID: 37870710 PMCID: PMC10781920 DOI: 10.1007/s12471-023-01823-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND In patients with ischaemic heart disease (IHD) aged > 70 years, Dutch and European guidelines recommend different treatment targets: low-density lipoprotein cholesterol (LDL-c) < 2.6 versus < 1.4 mmol/l and systolic blood pressure (SBP) < 140 versus < 130 mm Hg, respectively. How this impacts cardiovascular event-free life expectancy has not been investigated. The study objective was to compare estimated lifelong treatment benefits of implementing Dutch and European LDL‑c and SBP targets. METHODS Data from patients aged 71-80 years hospitalised for IHD in 2017-2019 were extracted from the PHARMO Database Network, which links primary and secondary healthcare settings, with follow-up until 31 December 2020. Potential benefit according to treatment strategy (in gain in event-free years) was estimated using the SMART-REACH model. RESULTS Of the 3003 eligible patients, 1186 (39%) had missing LDL‑c and/or SBP measurements. Of the 1817 included patients (36% women, median age at event: 74 years (interquartile range (IQR): 72-77), 84% achieved the Dutch targets for both LDL‑c and SBP; for European targets, this was 23% and 61%, respectively. If Dutch targets were met for LDL‑c and SBP (n = 1281), the additional effect of reaching European targets was a median gain of 0.6 event-free life years (IQR: 0.3-1.0). The greatest effect could be reached in patients not reaching Dutch targets (n = 501), with a median gain of 0.6 (IQR: 0.2-1.2) and 1.7 (IQR: 1.2-2.5) event-free years with Dutch versus European targets. CONCLUSION In patients aged > 70 years with IHD, implementation of European targets resulted in a greater gain of event-free years compared with Dutch targets, especially in patients with poorer risk factor control. The considerable number of patients with missing risk factor documentation suggested additional opportunities for risk reduction.
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Affiliation(s)
- Tinka J van Trier
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
| | - Marjolein Snaterse
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Ron M C Herings
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Centres, location Free University Medical Centre, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
- Department of General Practice, Amsterdam University Medical Centres, location Free University Medical Centre, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
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Megna R, Petretta M, Nappi C, Assante R, Zampella E, Gaudieri V, Mannarino T, D’Antonio A, Green R, Cantoni V, Panico M, Acampa W, Cuocolo A. Age-Specific Cardiovascular Risk Factors for Major Adverse Cardiac Events in Patients Undergoing Myocardial Perfusion Imaging. J Cardiovasc Dev Dis 2023; 10:395. [PMID: 37754824 PMCID: PMC10531606 DOI: 10.3390/jcdd10090395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The prevalence of traditional cardiovascular risk factors shows different age-specific patterns. It is not known whether the prognostic impact of risk factors is similarly age-specific. We evaluated the profiles of cardiovascular risk factors and their prognostic impact on coronary artery disease (CAD) in relation to age. METHODS We included 3667 patients with suspected or known CAD undergoing stress myocardial perfusion imaging (MPI). We evaluated the risk for major adverse cardiac events (MACE) within three years from the index MPI in patients belonging to three groups according to age tertile distribution: <59, 59-68, and >68 years. Gender, body mass index, diabetes, hypertension, dyslipidemia, family history of CAD, smoking, angina, dyspnea, previous CAD, and MPI outcome were assessed as risk factors by a multivariable Cox's regression. RESULTS The three-year risk of MACE increased progressively with age and was 9%, 13%, and 18% for each group, respectively (p < 0.0001). Dyspnea and abnormal MPI outcome were significant risk factors for all age groups. Diabetes and smoking were significant from the age of 59 onwards, while hypertension resulted significant for patients older than 68 years. CONCLUSIONS The number of risk factors was significantly associated with the occurrence of MACE increase with age. It is noteworthy that a personal history of CAD was not useful for risk stratification, while MPI results were.
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Affiliation(s)
- Rosario Megna
- Institute of Biostructure and Bioimaging, National Council of Research, via T. De Amicis 95, 80145 Naples, Italy;
| | - Mario Petretta
- IRCCS Synlab SDN, via Gianturco 113, 80143 Naples, Italy;
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Adriana D’Antonio
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, via T. De Amicis 95, 80145 Naples, Italy;
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131 Naples, Italy; (C.N.); (R.A.); (E.Z.); (V.G.); (T.M.); (A.D.); (R.G.); (V.C.); (W.A.); (A.C.)
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