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Wang TS, Kim ES, Duh QY, Gosain A, Kao LS, Kothari AN, Tsai S, Tseng JF, Tsung A, Wang KS, Wexner SD. Proceedings From the Advances in Surgery Channel Diversity, Equity, and Inclusion Series: Lessons Learned From Asian Academic Surgeons. J Surg Res 2022; 278:14-30. [PMID: 35588571 DOI: 10.1016/j.jss.2022.04.030] [Citation(s) in RCA: 2] [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] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
In this series of talks and the accompanying panel session, leaders from the Society of Asian Academic Surgeons discuss issues faced by Asian Americans and the importance of the role of mentors and allyship in professional development in the advancement of Asian Americans in leadership roles. Barriers, including the model minority myth, are addressed. The heterogeneity of the Asian American population and disparities in healthcare and in research, specifically as relates to Asian Americans, also are examined.
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Affiliation(s)
- Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Eugene S Kim
- Department of Surgery, Children's Hospital of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Quan-Yang Duh
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Ankush Gosain
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas
| | - Anai N Kothari
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center and Boston University, Boston, Massachusetts
| | - Allan Tsung
- Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Kasper S Wang
- Department of Surgery, Children's Hospital of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
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Kawsara A, El Shaer A, Khalouf A, Almakadma AH, Alkhouli M. Differences in Risk Profile, Management, and Outcomes of ST-Elevation Myocardial Infarction Between Asian Versus White Patients in Contemporary United States Practice. Am J Cardiol 2021; 160:132-3. [PMID: 34740393 DOI: 10.1016/j.amjcard.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 01/25/2023]
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Chichareon P, Nilmoje T, Suriyaamorn W, Preechawettayakul I, Suwanugsorn S. Predicting mortality in cardiac care unit patients: external validation of the Mayo cardiac intensive care unit admission risk score. Eur Heart J Acute Cardiovasc Care 2021; 10:1065-1073. [PMID: 34448824 DOI: 10.1093/ehjacc/zuab070] [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] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/15/2021] [Accepted: 08/05/2021] [Indexed: 11/12/2022]
Abstract
AIMS The Mayo Cardiac Intensive Care Unit Admission Risk Score (M-CARS) had excellent performance in predicting in-hospital mortality in the US population. We sought to validate the M-CARS for in-hospital and post-discharge mortality in Asian patients admitted to the cardiac care unit (CCU). METHODS AND RESULTS Patients admitted to the CCU of a tertiary care centre between July 2015 and December 2019 were included into the study. Patients with intra-hospital transfer to the CCU due to intensive care unit overflow, postoperative cardiac surgery, or for monitoring after elective procedures were excluded. Cardiac arrest, cardiogenic shock, respiratory failure, Braden skin score, blood urea nitrogen, anion gap, and red cell distribution width, were used to calculate the M-CARS. Patients were stratified into three groups, according to the M-CARS (<2, 2-6, >6). Of 1988 patients in the study, 30.1% were female with a median age of 65 years. Prevalence of cardiogenic shock and respiratory failure at admission were 2.8% and 4.5%, respectively. One hundred and seventeen patients died during the admission (mortality rate of 5.9%). The in-hospital mortality rate in patients with M-CARS of <2, 2-6, and >6 was 1.1%, 9.8%, and 35.5%, respectively. C-statistic of M-CARS for in-hospital mortality was 0.840 (95% CI 0.805-0.873); whereas, it was 0.727 (95% CI 0.690-0.761) for 1-year post-discharge mortality. Calibration plot showed good agreement between predicted and observed in-hospital mortality in the majority of patients. CONCLUSIONS The M-CARS was useful in our study, in terms of discrimination and calibration. M-CARS identified high-risk patients in CCU, who had unacceptably high mortality rate during hospital stay and thereafter.
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Affiliation(s)
- Ply Chichareon
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.,Naradhiwas Rajanagarindra Heart Center, Songklanagarind Hospital, Songkhla 90110, Thailand
| | - Thanapon Nilmoje
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Wisanuwee Suriyaamorn
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Ittipon Preechawettayakul
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Saranyou Suwanugsorn
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Ishida T, Arima Y, Mizuno Y, Harada E, Yamashita T, Sueta D, Sakamoto K, Suzuki S, Kaikita K, Yamada Y, Shimomura H, Oniki K, Saruwatari J, Hokimoto S, Yasue H, Tsujita K. East Asian variant aldehyde dehydrogenase type 2 genotype exacerbates ischemia/reperfusion injury with ST-elevation myocardial infarction in men: possible sex differences. Heart Vessels 2021. [PMID: 34259924 DOI: 10.1007/s00380-021-01907-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Mitochondrial aldehyde dehydrogenase 2 (ALDH2) detoxifies toxic aldehydes generated during ischemia/reperfusion (I/R) injury in ST-elevation myocardial infarction (STEMI). The deficient variant ALDH2 genotype (ALDH2*2) is prevalent among East Asians. Whether ALDH2*2 exacerbates I/R injury of in patients with STEMI is not known. The study subjects comprised 218 Japanese patients with STEMI (158 men and 60 women, mean age 67.9 ± 11.9) who underwent successful percutaneous coronary intervention. Of these, 120 (55.0%) were the carriers of variant ALDH2*2 and 98 (45.0%) those of wild ALDH2*1/*1 on genotyping. There were no differences in clinical characteristics between the ALDH2*2 and ALDH2*1/*1 group except lower alcohol habit (14.2% vs 46.3%, P < 0.001) in the ALDH2*2 group. The peak plasma levels of creatine phosphokinase myocardial binding (CKMB), a marker of myocardial injury, however, were significantly higher in the patients with ALDH2*2 than in those with ALDH2*1/*1 [a median 275.0 (175.8-407.5) vs 177.5 (126.9-344.3) U/L, P = 0.001] among men but not among women (P = 0.811). There was a significant interaction between men (male sex) and ALDH2*2 for I/R injury (χ2 = 4.425, P = 0.040). The variant ALDH2*2 was associated with more severe I/R injury than the wild ALDH2*1/*1 in STEMI patients in men with possible sex differences.
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5
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Li YH, Lee CH, Huang WC, Wang YC, Su CH, Sung PH, Chien SC, Hwang JJ. 2020 Focused Update of the 2012 Guidelines of the Taiwan Society of Cardiology for the Management of ST-Segment Elevation Myocardial Infarction. Acta Cardiol Sin 2020; 36:285-307. [PMID: 32675921 PMCID: PMC7355116 DOI: 10.6515/acs.202007_36(4).20200619a] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
One of the major missions of the Taiwan Society of Cardiology is to publish practice guidelines that are suitable for local use in Taiwan. The ultimate purpose is to continuously improve cardiovascular health care from the implementation of the recommendations in the guidelines. Despite recent improvement of medical care, patients with ST-segment elevation myocardial infarction (STEMI) still carry a high morbidity and mortality. There have been many changes in the concepts of STEMI diagnosis and treatment in recent years. The 2020 focused update of the 2012 guidelines of the Taiwan Society of Cardiology for the management of STEMI is an amendment of the 2012 guidelines based on the newest published scientific data. The recommendations in this focused update provide the diagnosis and treatment strategy for STEMI that should be generally implemented in Taiwan. Nevertheless, guidelines never completely replace clinical judgment and medical decision still should be determined individually.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Cheng-Han Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang Ming University, Taipei
- Department of Physical Therapy, Fooyin University, Kaohsiung
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital
- Department of Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
| | - Pei-Hsun Sung
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine
| | - Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Abstract
Background Prior data demonstrate significant heterogeneity regarding coronary artery disease risk factors and outcomes among Asians in the United States, but no studies have yet examined coronary artery disease treatment patterns or outcomes among disaggregated Asian American subgroups. Methods and Results From a total of 772 882 patients with known race/ethnicity and sex who received care from a mixed‐payer healthcare organization in Northern California between 2006 and 2015, a retrospective analysis was conducted on 6667 adults with coronary artery disease. Logistic regression was used to examine medical and procedural therapies and outcomes by race/ethnicity, with adjustment for age, sex, income, and baseline comorbidities. Compared with non‐Hispanic whites, Chinese were more likely to undergo stenting (50.9% versus 60.8%, odds ratio [OR] 1.39 [95% CI, 1.04–1.87], p=0.005), whereas Filipinos were more likely to receive bypass surgery (6.9% versus 20.5%, OR 2.65 [95% CI, 1.75–4.01], P<0.0001). After stenting, Chinese, Filipinos, and Japanese were more likely than non‐Hispanic whites to be prescribed clopidogrel (86.2%, 83.0%, and 91.4% versus 74.5%, ORs 1.86 [95% CI, 1.13–3.04], 1.86 [95% CI, 1.01–3.44], and 4.37 [95% CI, 1.02–18.67], respectively, P<0.0001). Lastly, Chinese and Asian Indians were more likely than non‐Hispanic whites to be diagnosed with a myocardial infarction within 1 year postangiography (15.6% and 17.4% versus 11.2%, ORs 1.49 [95% CI, 1.02–2.19] and 1.68 [95% CI, 1.21–2.34], respectively, P<0.0001). Conclusions Disaggregation of Asian Americans with coronary artery disease into individual racial/ethnic subgroups reveals significant variability in treatment patterns and outcomes. Further investigation into these differences may expose important opportunities to mitigate disparities and improve quality of care in this diverse population.
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Affiliation(s)
- Lakshman Manjunath
- Division of Cardiology Stanford University Stanford CA.,Stanford Cardiovascular Institute Stanford CA
| | - Sukyung Chung
- Palo Alto Medical Foundation's Research Institute Palo Alto CA
| | - Jiang Li
- Palo Alto Medical Foundation's Research Institute Palo Alto CA
| | - Harsh Shah
- Institute for Stem Cell Biology and Regenerative Medicine Stanford University School of Medicine Stanford CA
| | - Latha Palaniappan
- Division of Cardiology Stanford University Stanford CA.,Stanford Cardiovascular Institute Stanford CA.,Palo Alto Medical Foundation's Research Institute Palo Alto CA
| | - Celina M Yong
- Division of Cardiology Stanford University Stanford CA.,Stanford Cardiovascular Institute Stanford CA.,VA Palo Alto Healthcare System Palo Alto CA
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Wu CK, Juang JJ, Chiang JY, Li YH, Tsai CT, Chiang FT. The Taiwan Heart Registries: Its Influence on Cardiovascular Patient Care. J Am Coll Cardiol 2018; 71:1273-83. [PMID: 29544612 DOI: 10.1016/j.jacc.2018.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
Taiwanese heart registries for the main cardiovascular diseases have been conducted in the past 10 years, with the goal of examining the quality of cardiovascular patient care, which cannot be guaranteed by the universal Taiwan National Health Insurance. The results show suboptimal adherence to guideline recommendations. Door-to-balloon time and dual antiplatelet therapy use in acute coronary syndrome, standard medications for management of heart failure, low-density lipoprotein cholesterol levels in dyslipidemia, anticoagulant agent use in atrial fibrillation, and the understanding of sudden arrhythmia death syndrome were all found to be inadequate. However, all were improved, either by changing National Health Insurance policy or through continuous education for physicians and patients. Thus, specific cardiovascular disease registries could help examine the status of real-world practice, find inadequacies in guideline implementation and understanding of rare diseases, facilitate lobbying to policy makers and education for physicians and patients, and influence and improve cardiovascular patient care.
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Yasue H, Mizuno Y, Harada E. Association of East Asian Variant Aldehyde Dehydrogenase 2 Genotype (ALDH2*2*) with Coronary Spasm and Acute Myocardial Infarction. Adv Exp Med Biol 2019; 1193:121-134. [PMID: 31368101 DOI: 10.1007/978-981-13-6260-6_7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Coronary spasm plays an important role in the pathogenesis of ischemic heart disease, including angina pectoris, acute myocardial infarction (AMI), silent myocardial ischemia, and sudden death. The prevalence of coronary spasm is higher among East Asians probably due to genetic as well as environmental factors. ALDH2 eliminates toxic aldehydes including 4-hydroxy-2-nonenal (4-HNE) derived from lipid peroxidation and acrolein in tobacco smoking as well as ethanol-derived acetaldehyde and thereby protects tissues and cells from oxidative damage. Deficient variant ALDH2*2 genotype is prevalent among East Asians and is a significant risk factor for both coronary spasm and AMI through accumulation of toxic aldehydes, thereby contributing to oxidative stress, endothelial damage, vasoconstriction, and thrombosis. Toxic aldehydes are thus identified as risk factors to be targeted for the treatment of coronary spasm and AMI.
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Affiliation(s)
- Hirofumi Yasue
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto City, Japan.
| | - Yuji Mizuno
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto City, Japan
| | - Eisaku Harada
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto City, Japan
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Li YH, Chiu YW, Cheng JJ, Hsieh IC, Lo PH, Lei MH, Ueng KC, Chiang FT, Sung SH, Kuo JY, Chen CP, Lai WT, Lee WL, Chen JH. Changing Practice Pattern of Acute Coronary Syndromes in Taiwan from 2008 to 2015. Acta Cardiol Sin 2019; 35:1-10. [PMID: 30713394 PMCID: PMC6342842 DOI: 10.6515/acs.201901_35(1).20180716b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/16/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS), including ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation (NSTE)-ACS have a significant risk of morbidity and mortality. This study evaluated the practice patterns of ACS care in Taiwan from 2005 to 2018. METHODS Data from two nationwide ACS registries (2008-2010 and 2012-2015) were used. ACS patients who received percutaneous coronary interventions (PCIs) during admission were compared between the two registries. RESULTS In STEMI, the door-to-balloon time for primary PCI decreased by 25 min from a median of 96 to 71 min (p < 0.0001) from the first to second registry. More complex PCI procedures and drug-eluting stents were used for ACS. However, the onset-to-door time was still long for both STEMI and NSTE-ACS. The D2B time for NSTE-ACS was long, especially in the elderly and female patients. Although the prescription rate of secondary preventive medications for ACS increased, it was still relatively low compared with Western data, especially in NSTE-ACS. CONCLUSIONS The registry data showed that ACS care quality has improved in Taiwan. However, areas including onset-to-door time and use of secondary preventive medications still need further improvements.
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Affiliation(s)
- Yi-Heng Li
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yu-Wei Chiu
- Far Eastern Memorial Hospital, New Taipei City
| | | | - I-Chang Hsieh
- Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Ping-Han Lo
- China Medical University Hospital and College of Medicine, Taichung
| | | | | | - Fu-Tien Chiang
- National Taiwan University Hospital and Fu-Jen Catholic University Hospital
| | - Shih-Hsien Sung
- Taipei Veterans General Hospital and National Yang Ming University
| | | | | | - Wen-Ter Lai
- Kaohsiung Medical University Hospital, Kaohsiung City
| | | | - Jyh-Hong Chen
- College of Medicine, China Medical University, Taichung, Taiwan
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Su TH, Chang SH, Chen PC, Chan YL. Temporal Trends in Treatment and Outcomes of Acute Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Observational Study. J Am Heart Assoc 2017; 6:e004525. [PMID: 28298371 PMCID: PMC5524002 DOI: 10.1161/jaha.116.004525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute myocardial infarction is a major cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD); however, temporal trends in the management and clinical outcomes of these patients remain unclear. METHODS AND RESULTS We conducted an observational study by using a representative sample of 1 million beneficiaries from the Taiwan National Health Insurance Research Database. Comorbidities, in-hospital treatment, and outcomes were compared for patients with acute myocardial infarction with and without COPD between 2004 and 2013. Temporal trends in treatment and outcomes were analyzed. We included 6770 patients admitted to hospitals with acute myocardial infarction diagnoses, of whom 1921 (28.3%) had COPD. Fewer patients with COPD received β-blockers (adjusted odds ratio 0.66, 95% CI 0.59-0.74), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (adjusted odds ratio 0.83, 95% CI 0.73-0.93), statins, anticoagulants, dual antiplatelets, and coronary interventions. These patients had higher mortality (in hospital: adjusted hazard ratio 1.25 [95% CI 1.11-1.41]; 1 year: adjusted hazard ratio 1.20 [95% CI 1.09-1.32]) and respiratory failure risk during admission. Temporal trends showed little improvement in mortality in patients with COPD over 10 years. Multivariable logistic regression indicated that dual antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, coronary angiography, and coronary artery bypass grafting surgery were significantly correlated with improved mortality in patients with COPD. CONCLUSIONS In Taiwan, a lower proportion of patients with COPD received evidence-based therapies for acute myocardial infarction than did patients without COPD, and their clinical outcomes were inferior. Limited improvement in mortality was observed over the preceding 10 years and is attributable to the underuse of evidence-based treatments.
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Affiliation(s)
- Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
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Hira RS, Bhatt DL, Fonarow GC, Heidenreich PA, Ju C, Virani SS, Bozkurt B, Petersen LA, Hernandez AF, Schwamm LH, Eapen ZJ, Albert MA, Liang L, Matsouaka RA, Peterson ED, Jneid H. Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG-CAD) Registry. J Am Heart Assoc 2016; 5:JAHA.116.004113. [PMID: 27792640 PMCID: PMC5121508 DOI: 10.1161/jaha.116.004113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Timely reperfusion after ST‐elevation myocardial infarction (STEMI) improves survival. Guidelines recommend primary percutaneous coronary intervention (PPCI) within 90 minutes of arrival at a PCI‐capable hospital. The alternative is fibrinolysis within 30 minutes for those in those for whom timely transfer to a PCI‐capable hospital is not feasible. Methods and Results We identified STEMI patients receiving reperfusion therapy at 229 hospitals participating in the Get With the Guidelines—Coronary Artery Disease (GWTG‐CAD) database (January 1, 2003 through December 31, 2008). Temporal trends in the use of fibrinolysis and PPCI, its timeliness, and in‐hospital mortality outcomes were assessed. We also assessed predictors of fibrinolysis versus PPCI and compliance with performance measures. Defect‐free care was defined as 100% compliance with all performance measures. We identified 29 190 STEMI patients, of whom 2441 (8.4%) received fibrinolysis; 38.2% of these patients achieved door‐to‐needle times ≤30 minutes. Median door‐to‐needle times increased from 36 to 60 minutes (P=0.005) over the study period. Among PPCI patients, median door‐to‐balloon times decreased from 94 to 64 minutes (P<0.0001) over the same period. In‐hospital mortality was higher with fibrinolysis than with PPCI (4.6% vs 3.3%, P=0.001) and did not change significantly over time. Patients receiving fibrinolysis were less likely to receive defect‐free care compared with their PPCI counterparts. Conclusions Use of fibrinolysis for STEMI has decreased over time with concomitant worsening of door‐to‐needle times. Over the same time period, use of PPCI increased with improvement in door‐to‐balloon times. In‐hospital mortality was higher with fibrinolysis than with PPCI. As reperfusion for STEMI continues to shift from fibrinolysis to PPCI, it will be critical to ensure that door‐to‐needle times and outcomes do not worsen.
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Affiliation(s)
- Ravi S Hira
- Division of Cardiology, University of Washington, Seattle, WA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA
| | | | - Paul A Heidenreich
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA Stanford University School of Medicine, Stanford, CA
| | - Christine Ju
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Salim S Virani
- Michael E. DeBakey VA Medical Center, Houston, TX Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX
| | - Biykem Bozkurt
- Michael E. DeBakey VA Medical Center, Houston, TX Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Laura A Petersen
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Lee H Schwamm
- Department of Neurology, TeleStroke and Acute Stroke Services, Boston, MA Institute for Heart, Vascular, and Stroke Care, Massachusetts General Hospital, Boston, MA Department of Neurology, Harvard Medical School, Boston, MA
| | - Zubin J Eapen
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Michelle A Albert
- Division of Cardiology, University of California at San Francisco, San Francisco, CA
| | - Li Liang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Hani Jneid
- Michael E. DeBakey VA Medical Center, Houston, TX Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
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Lee PT, Chao TH, Huang YL, Lin SH, Wang WM, Lee WH, Huang CW, Lee CH, Chen JY, Lin CC, Liu PY, Chan SH, Liu YW, Tsai WC, Lin LJ, Tsai LM, Li YH. Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014. Int Heart J 2016; 57:541-6. [PMID: 27581671 DOI: 10.1536/ihj.15-454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death.
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Affiliation(s)
- Po-Tseng Lee
- Department of Internal Medicine, Institute of Clinical Medicine and Biostatistics Consulting Center, National Cheng Kung University Hospital and College of Medicine
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Mizuno Y, Hokimoto S, Harada E, Kinoshita K, Nakagawa K, Yoshimura M, Ogawa H, Yasue H. Variant Aldehyde Dehydrogenase 2 (ALDH2*2) Is a Risk Factor for Coronary Spasm and ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2016; 5:e003247. [PMID: 27153870 PMCID: PMC4889196 DOI: 10.1161/jaha.116.003247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mitochondrial aldehyde dehydrogenase 2 (ALDH2) plays a key role in removing toxic aldehydes. Deficient variant ALDH2*2 genotype is prevalent in up to 40% of the East Asians and reported to be associated with acute myocardial infarction (AMI). To elucidate the mechanisms underlying the association of ALDH2*2 with AMI, we compared the clinical features of AMI patients with ALDH2*2 to those with wild-type ALDH2*1/*1. METHODS AND RESULTS The study subjects consisted of 202 Japanese patients with acute ST-segment elevation myocardial infarction (STEMI) (156 men and 46 women; mean age, 67.3±12.0) who underwent primary percutaneous coronary intervention (PCI). In 85 patients, provocation test for coronary spasm was also done 6 month post-PCI. ALDH2 genotyping was performed by direct application of the TaqMan polymerase chain system. Of the 202 patients, 103 (51.0%) were carriers of ALDH2*2 and 99 (49.0%) those of ALDH2*1/*1. There were no differences in clinical features between ALDH2*2 and ALDH2*1/*1 carrier groups except higher frequencies of coronary spasm and alcohol flush syndrome (AFS) (88.6% vs 56.1%; P=0.001 and 94.3% vs 17.6%; P<0.001), less-frequent alcohol habit (14.6% vs 51.5%; P<0.001), and higher peak plasma creatine phophokinase levels (2224 vs 1617 mg/dL; P=0.002) in the ALDH2*2 than the ALDH2*1/*1 carrier group. CONCLUSIONS ALDH2*2 is prevalent (51.0%) among Japanese STEMI patients, and those with ALDH2*2 had higher frequencies of coronary spasm and AFS and more-severe myocardial injury compared to those with ALDH2*1/*1.
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Affiliation(s)
- Yuji Mizuno
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Faculty of Life Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eisaku Harada
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan
| | - Kenji Kinoshita
- School of Pharmaceutical Sciences, Mukogawa Women's University, Koshien Nishinomiya, Japan
| | - Kazuko Nakagawa
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Faculty of Life Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Yasue
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan
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Li S, Fonarow GC, Mukamal KJ, Liang L, Schulte PJ, Smith EE, DeVore A, Hernandez AF, Peterson ED, Bhatt DL. Sex and Race/Ethnicity–Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circ Cardiovasc Qual Outcomes 2016; 9:S36-44. [DOI: 10.1161/circoutcomes.115.002621] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Zhang Q, Zhao D, Xie W, Xie X, Guo M, Wang M, Wang W, Liu W, Liu J. Recent Trends in Hospitalization for Acute Myocardial Infarction in Beijing: Increasing Overall Burden and a Transition From ST-Segment Elevation to Non-ST-Segment Elevation Myocardial Infarction in a Population-Based Study. Medicine (Baltimore) 2016; 95:e2677. [PMID: 26844503 PMCID: PMC4748920 DOI: 10.1097/md.0000000000002677] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Comparable data on trends of hospitalization rates for ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) remain unavailable in representative Asian populations.To examine the temporal trends of hospitalization for acute myocardial infarction (AMI) and its subtypes in Beijing.Patients hospitalized for AMI in Beijing from January 1, 2007 to December 31, 2012 were identified from the validated Hospital Discharge Information System. Trends in hospitalization rates, in-hospital mortality, length of stay (LOS), and hospitalization costs were analyzed by regression models for total AMI and for STEMI and NSTEMI separately. In total, 77,943 patients were admitted for AMI in Beijing during the 6 years, among whom 67.5% were males and 62.4% had STEMI. During the period, the rate of AMI hospitalization per 100,000 population increased by 31.2% (from 55.8 to 73.3 per 100,000 population) after age standardization, with a slight decrease in STEMI but a 3-fold increase in NSTEMI. The ratio of STEMI to NSTEMI decreased dramatically from 6.5:1.0 to 1.3:1.0. The age-standardized in-hospital mortality decreased from 11.2% to 8.6%, with a significant decreasing trend evident for STEMI in males and females (P < 0.001) and for NSTEMI in males (P = 0.02). The rate of percutaneous coronary intervention increased from 28.7% to 55.6% among STEMI patients. The total cost for AMI hospitalization increased by 56.8% after adjusting for inflation, although the LOS decreased by 1 day.The hospitalization burden for AMI has been increasing in Beijing with a transition from STEMI to NSTEMI. Diverse temporal trends in AMI subtypes from the unselected "real-world" data in Beijing may help to guide the management of AMI in China and other developing countries.
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Affiliation(s)
- Qian Zhang
- From the Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases (QZ, DZ, WX, MW, WW, JL), and Beijing Public Health Information Center, Beijing, China (XX, MG, WL)
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16
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Gijsberts CM, Seneviratna A, Hoefer IE, Agostoni P, Rittersma SZH, Pasterkamp G, Hartman M, Pinto de Carvalho L, Richards AM, Asselbergs FW, de Kleijn DPV, Chan MY. Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients. PLoS One 2015; 10:e0131977. [PMID: 26147437 PMCID: PMC4492790 DOI: 10.1371/journal.pone.0131977] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
Background Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic “synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery” (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays. Methods We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality. Results Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02). Conclusion Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.
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Affiliation(s)
- Crystel M. Gijsberts
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands
| | | | - Imo E. Hoefer
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Leonardo Pinto de Carvalho
- Cardiac Department, National University Hospital, Singapore
- Department of Cardiology, Albert Einstein Hospital, Sao Paulo, Brazil
| | - A. Mark Richards
- Cardiac Department, National University Hospital, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
| | - Folkert W. Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
- Institute of Cardiovascular Science, faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Dominique P. V. de Kleijn
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
- * E-mail:
| | - Mark Y. Chan
- Cardiac Department, National University Hospital, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
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Gurwitz JH, Magid DJ, Smith DH, Hsu G, Sung SH, Allen LA, McManus DD, Goldberg RJ, Go AS; Cardiovascular Research Network PRESERVE Study. The complex relationship of race to outcomes in heart failure with preserved ejection fraction. Am J Med 2015; 128:591-600. [PMID: 25554372 DOI: 10.1016/j.amjmed.2014.11.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 11/22/2014] [Accepted: 11/24/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction. METHODS We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. RESULTS Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR, 1.48; 95% CI, 1.29-1.68); no difference was observed for Asians compared with whites (HR, 1.01; 95% CI, 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR, 1.03; 95% CI, 0.95-1.12) and Asians (HR, 0.93; 95% CI, 0.85-1.02). CONCLUSIONS In a diverse population with heart failure with preserved ejection fraction, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race.
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18
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Qian F, Fonarow GC, Krim SR, Vivo RP, Cox M, Hannan EL, Shaw BA, Hernandez AF, Eapen ZJ, Yancy CW, Bhatt DL. Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program. Int J Cardiol 2015; 189:141-7. [PMID: 25889445 DOI: 10.1016/j.ijcard.2015.03.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. METHODS We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. RESULTS Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk <RR>, 0.88; 95% confidence interval <CI>, 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). CONCLUSIONS Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts.
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Affiliation(s)
- Feng Qian
- University at Albany-State University of New York, Albany, United States.
| | - Gregg C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Rey P Vivo
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | | | - Edward L Hannan
- University at Albany-State University of New York, Albany, United States
| | - Benjamin A Shaw
- University at Albany-State University of New York, Albany, United States
| | | | | | | | - Deepak L Bhatt
- VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
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19
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Gross ER, Zambelli VO, Small BA, Ferreira JCB, Chen CH, Mochly-Rosen D. A personalized medicine approach for Asian Americans with the aldehyde dehydrogenase 2*2 variant. Annu Rev Pharmacol Toxicol 2014; 55:107-27. [PMID: 25292432 DOI: 10.1146/annurev-pharmtox-010814-124915] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Asian Americans are one of the fastest-growing populations in the United States. A relatively large subset of this population carries a unique loss-of-function point mutation in aldehyde dehydrogenase 2 (ALDH2), ALDH2*2. Found in approximately 560 million people of East Asian descent, ALDH2*2 reduces enzymatic activity by approximately 60% to 80% in heterozygotes. Furthermore, this variant is associated with a higher risk for several diseases affecting many organ systems, including a particularly high incidence relative to the general population of esophageal cancer, myocardial infarction, and osteoporosis. In this review, we discuss the pathophysiology associated with the ALDH2*2 variant, describe why this variant needs to be considered when selecting drug treatments, and suggest a personalized medicine approach for Asian American carriers of this variant. We also discuss future clinical and translational perspectives regarding ALDH2*2 research.
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Affiliation(s)
- Eric R Gross
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California 94305
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20
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Soto M, Buitrago AF, Gómez M, Celis É. Indicadores de calidad en la atención de pacientes con infarto agudo de miocardio. Revista Colombiana de Cardiología 2014. [DOI: 10.1016/j.rccar.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lee CH, Cheng CL, Yang YHK, Chao TH, Chen JY, Liu PY, Lin CC, Chan SH, Tsai LM, Chen JH, Lin LJ, Li YH. Trends in the incidence and management of acute myocardial infarction from 1999 to 2008: get with the guidelines performance measures in Taiwan. J Am Heart Assoc 2014; 3:jah3648. [PMID: 25112555 PMCID: PMC4310397 DOI: 10.1161/jaha.114.001066] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. Methods and Results We used the Taiwan National Health Insurance Research Database (1999–2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age‐adjusted incidence of AMI (/100 000 person‐years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline‐based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β‐blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in‐hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, β‐blocker, and statin use during hospitalization were all associated with reduced in‐hospital mortality in our AMI patients. Conclusions AMI incidence was increasing, but the guideline‐based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.
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Affiliation(s)
- Cheng-Han Lee
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Ching-Lan Cheng
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.L.C., Y.H.K.Y.)
| | - Yea-Huei Kao Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.L.C., Y.H.K.Y.)
| | - Ting-Hsing Chao
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Ju-Yi Chen
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Ping-Yen Liu
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Chih-Chan Lin
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Shih-Hung Chan
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Liang-Miin Tsai
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Jyh-Hong Chen
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Li-Jen Lin
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Yi-Heng Li
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
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Abstract
Heart failure (HF) carries a major burden of disease in East Asia, with high associated risk of mortality and morbidity. In recent decades, the epidemiology of HF has changed with social and economical development in East Asia. The burden of HF is still severe in East Asia. The prevalence of HF ranges from 1.3% to 6.7% throughout the region. As aetiological factors, ischaemic heart disease has increased and valvular disease reduced in most East Asian countries. Diuretics are the most commonly used drugs (51.0%-97%), followed by renin-angiotensin system (RAS) inhibitors (59%-77%), with angiotensin-converting enzyme inhibitors, ACEI, (32%-52%) and has angiotensin-2 receptor blockers, ARBs (31%-44%) in similar proportions. β-blocker use has also increased in recent years. Total mortality from HF ranges from 2% to 9% in China, Taiwan, Singapore, Thailand, and Japan. Age>65 years, diabetes mellitus, anaemia, renal dysfunction and atrial fibrillation (AF) are associated with adverse outcome. More prospective, region-specific data are still required, particularly regarding new drug therapies such as eplerenone and ivabradine.
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Affiliation(s)
- Yutao Guo
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
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Ellrodt AG, Fonarow GC, Schwamm LH, Albert N, Bhatt DL, Cannon CP, Hernandez AF, Hlatky MA, Luepker RV, Peterson PN, Reeves M, Smith EE. Synthesizing lessons learned from get with the guidelines: the value of disease-based registries in improving quality and outcomes. Circulation 2013; 128:2447-60. [PMID: 24166574 DOI: 10.1161/01.cir.0000435779.48007.5c] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Mody P, Gupta A, Bikdeli B, Lampropulos JF, Dharmarajan K. Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities. Circ Cardiovasc Qual Outcomes 2012; 5. [DOI: 10.1161/circoutcomes.112.967638] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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