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Soloveva A, Gale CP, Han NT, Hurdus B, Aktaa S, Palin V, Mebrahtu TF, Van Spall H, Batra G, Dondo TB, Bäck M, Munyombwe T. Associations of health-related quality of life with major adverse cardiovascular and cerebrovascular events for individuals with ischaemic heart disease: systematic review, meta-analysis and evidence mapping. Open Heart 2023; 10:e002452. [PMID: 37890894 PMCID: PMC10619110 DOI: 10.1136/openhrt-2023-002452] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD). METHODS Medline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the studies. Descriptive synthesis, evidence mapping and random-effects meta-analysis were performed stratified by HRQoL measures and effect estimates. Between-study heterogeneity was assessed using the Higgins I2 statistic. RESULTS Fifty-one articles were included with a total of 134 740 participants from 53 countries. Meta-analysis of 23 studies found that the risk of MACCE increased with lower baseline HeartQoL score (HR 1.49, 95% CI 1.16 to 1.93) and Short Form Survey (SF-12) physical component score (PCS) (HR 1.39, 95% CI 1.28 to 1.51). Risk of all-cause mortality increased with a lower HeartQoL (HR 1.64, 95% CI 1.34 to 2.01), EuroQol 5-dimension (HR 1.17, 95% CI 1.12 to 1.22), SF-36 PCS (HR 1.29, 95% CI 1.19 to 1.41), SF-36 mental component score (HR 1.18, 95% CI 1.08 to 1.30). CONCLUSIONS This study found an inverse association between baseline values or change in HRQoL and MACCE or components of MACCE in individuals with IHD, albeit with between-study heterogeneity. Standardisation and routine assessment of HRQoL in clinical practice may help risk stratify individuals with IHD for tailored interventions. PROSPERO REGISTRATION NUMBER CRD42021234638.
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Affiliation(s)
- Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research Centre, Sankt-Peterburg, Russian Federation
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Naung Tun Han
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Ben Hurdus
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Suleman Aktaa
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Victoria Palin
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Teumzghi F Mebrahtu
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Harriette Van Spall
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Gorav Batra
- Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tatendashe Bernadette Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Maria Bäck
- Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
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2
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Ishak D, Aktaa S, Lindhagen L, Alfredsson J, Dondo TB, Held C, Jernberg T, Yndigegn T, Gale CP, Batra G. Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes. Heart 2023; 109:1159-1165. [PMID: 37130746 PMCID: PMC10359586 DOI: 10.1136/heartjnl-2022-322115] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/14/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Beta-blockers (BB) are an established treatment following myocardial infarction (MI). However, there is uncertainty as to whether BB beyond the first year of MI have a role in patients without heart failure or left ventricular systolic dysfunction (LVSD). METHODS A nationwide cohort study was conducted including 43 618 patients with MI between 2005 and 2016 in the Swedish register for coronary heart disease. Follow-up started 1 year after hospitalisation (index date). Patients with heart failure or LVSD up until the index date were excluded. Patients were allocated into two groups according to BB treatment. Primary outcome was a composite of all-cause mortality, MI, unscheduled revascularisation and hospitalisation for heart failure. Outcomes were analysed using Cox and Fine-Grey regression models after inverse propensity score weighting. RESULTS Overall, 34 253 (78.5%) patients received BB and 9365 (21.5%) did not at the index date 1 year following MI. The median age was 64 years and 25.5% were female. In the intention-to-treat analysis, the unadjusted rate of primary outcome was lower among patients who received versus not received BB (3.8 vs 4.9 events/100 person-years) (HR 0.76; 95% CI 0.73 to 1.04). Following inverse propensity score weighting and multivariable adjustment, the risk of the primary outcome was not different according to BB treatment (HR 0.99; 95% CI 0.93 to 1.04). Similar findings were observed when censoring for BB discontinuation or treatment switch during follow-up. CONCLUSION Evidence from this nationwide cohort study suggests that BB treatment beyond 1 year of MI for patients without heart failure or LVSD was not associated with improved cardiovascular outcomes.
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Affiliation(s)
- Divan Ishak
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Suleman Aktaa
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Tatendashe Bernadette Dondo
- Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | | | - Chris P Gale
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Gorav Batra
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
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3
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Dondo TB, Munyombwe T, Hall M, Hurdus B, Soloveva A, Oliver G, Aktaa S, West RM, Hall AS, Gale CP. Sex differences in health-related quality of life trajectories following myocardial infarction: national longitudinal cohort study. BMJ Open 2022; 12:e062508. [PMID: 36351712 PMCID: PMC9644325 DOI: 10.1136/bmjopen-2022-062508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To investigate sex-based differences in baseline values and longitudinal trajectories of health-related quality of life (HRQoL) in a large cohort of myocardial infarction (MI) survivors after adjusting for other important factors. DESIGN Longitudinal cohort study. SETTING Population-based longitudinal study the Evaluation of the Methods and Management of Acute Coronary Events study linked with national cardiovascular registry. Data were collected from 77 hospitals in England between 1 November 2011 and 24 June 2015. PARTICIPANTS 9551 patients with MI. Patients were eligible for the study if they were ≥18 years of age. PRIMARY AND SECONDARY OUTCOME MEASURES HRQoL was measured by EuroQol five-dimension, visual analogue scale (EQ-5D, EQ VAS) survey at baseline, 1, 6 and 12 months after discharge. Multi-level linear and logistic regression models coupled with inverse probability weighted propensity scoring were used to evaluate sex differences in HRQoL following MI. RESULTS Of the 9551 patients with MI and complete data on sex, 25.1% (2,397) were women. At baseline, women reported lower HRQoL (EQ VAS (mean (SD) 59.8 (20.4) vs 64.5 (20.9)) (median (IQR) 60.00 (50.00-75.00) vs 70.00 (50.00-80.00))) (EQ-5D (mean (SD) 0.66 (0.31) vs 0.74 (0.28)) (median (IQR) 0.73 (0.52-0.85) vs 0.81 (0.62-1.00))) and were more likely to report problems in each HRQoL domain compared with men. In the covariate balanced and adjusted multi-level model sex differences in HRQoL persisted during follow-up, with lower EQ VAS and EQ-5D scores in women compared with men (adjusted EQ VAS model sex coefficient: -4.41, 95% CI -5.16 to -3.66 and adjusted EQ-5D model sex coefficient: -0.07, 95% CI -0.08 to -0.06). CONCLUSIONS Women have lower HRQoL compared with men at baseline and during 12 months follow-up after MI. Tailored interventions for women following an MI could improve their quality of life. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04598048, NCT01808027, NCT01819103.
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Affiliation(s)
- Tatendashe Bernadette Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Ben Hurdus
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Anzhela Soloveva
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | | | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alistair S Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
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4
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Ishak D, Aktaa S, Lindhagen L, Alfredsson J, Dondo TB, Held C, Jernberg T, Yndigegn T, Gale CP, Batra G. Association of beta-blockers beyond 1 year after myocardial infarction for patients without heart failure or left ventricular systolic dysfunction and cardiovascular outcomes: nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Abstract
Abstract
Background
Beta-blockers (BB) is an established treatment following presentation with myocardial infarction (MI). However, there is uncertainty as to whether BB use beyond the first year of MI has a secondary preventive role in patients without heart failure and/or left ventricular systolic dysfunction (LVSD).
Purpose
To investigate the association between BB treatment beyond one year after MI for patients without heart failure or LVSD and cardiovascular (CV) outcomes.
Methods
We used data from SWEDEHEART, the national Swedish register for coronary heart disease, to identify patients with MI who were hospitalised between 2005 and 2016. Deterministic linkage of individual patient data was performed with the National Patient Register, the Swedish Prescribed Drug Register, and the National Cause of Death Register. Patients with heart failure or LVSD with left ventricular ejection fraction <50% were excluded. Follow-up started at 1 year after hospitalisation with first MI (index date), when patients were allocated into two groups according to BB treatment. Information about BB treatment at index date and during follow-up was obtained from the Swedish National Prescribed Drug Register. The primary outcome was a composite of all-cause mortality, recurrent MI, unscheduled revascularisation or hospitalisation for heart failure. Secondary outcomes comprised the individual components of the composite outcome, CV death and stroke. Comparison of outcomes between the study groups was performed using Cox and Fine-Gray regression models adjusting for relevant clinical factors after propensity-score weighting. In the main intention-to-treat analysis, patients were censored at end of follow-up (31st December 2017), death or at pre-specified outcome, whichever came first. In supplementary per-protocol analysis, patients were, in addition, censored at the time of first BB discontinuation or switch between treatment arms.
Results
A total of 43,618 patients with MI were hospitalised between 2005 and 2016. Of these, 34,253 (78.5%) were prescribed BB and 9,365 (21.5%) were not on BB treatment at index date 1 year following MI. The median age of the population was 64 years, 25.5% were female, and 36.2% had a STEMI. Median follow-up was 4.5 years. In the intention-to-treat analysis, and after multivariable adjustments and propensity score weighting, BB treatment was associated with a similar rate of the composite CV outcome (hazard ratio [HR] 0.99; 95% confidence interval [CI] 0.93–1.04) compared with no BB treatment. A similar finding was observed when censoring for BB discontinuation or treatment switch during follow-up in a per-protocol analysis (HR 0.98; 95% CI 0.98–1.06). Similar associations were observed for all secondary outcomes (Figure 1).
Conclusions
BB treatment beyond one year after MI for patients without heart failure or LVSD is not associated with a different risk of cardiovascular outcomes compared with patients who do not receive BB.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement.
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Affiliation(s)
- D Ishak
- Uppsala University, Department of Medical Sciences, Cardiology , Uppsala , Sweden
| | - S Aktaa
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds Institute for Data Analytics , Leeds , United Kingdom
| | - L Lindhagen
- Uppsala University, Uppsala Clinical Research Center , Uppsala , Sweden
| | - J Alfredsson
- Linköping University, Department of Health, Medicine and Caring Sciences and Department of Cardiology , Linköping , Sweden
| | - T B Dondo
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds Institute for Data Analytics , Leeds , United Kingdom
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center , Uppsala , Sweden
| | - T Jernberg
- Danderyd University Hospital, Division of Cardiovascular Medicine, Department of Clinical Sciences , Stockholm , Sweden
| | - T Yndigegn
- Lund University, Department of Cardiology , Lund , Sweden
| | - C P Gale
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds Institute for Data Analytics , Leeds , United Kingdom
| | - G Batra
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center , Uppsala , Sweden
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5
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Munyombwe T, Dondo TB, Aktaa S, Wilkinson C, Hall M, Hurdus B, Oliver G, West RM, Hall AS, Gale CP. Association of multimorbidity and changes in health-related quality of life following myocardial infarction: a UK multicentre longitudinal patient-reported outcomes study. BMC Med 2021; 19:227. [PMID: 34579718 PMCID: PMC8477511 DOI: 10.1186/s12916-021-02098-y] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Multimorbidity is prevalent for people with myocardial infarction (MI), yet previous studies investigated single-health conditions in isolation. We identified patterns of multimorbidity in MI survivors and their associations with changes in HRQoL. METHODS In this national longitudinal cohort study, we analysed data from 9566 admissions with MI from 77 National Health Service hospitals in England between 2011 and 2015. HRQoL was measured using EuroQol 5 dimension (EQ5D) instrument and visual analogue scale (EQVAS) at hospitalisation, 6, and 12 months following MI. Latent class analysis (LCA) of pre-existing long-term health conditions at baseline was used to identify clusters of multimorbidity and associations with changes in HRQoL quantified using mixed effects regression analysis. RESULTS Of 9566 admissions with MI (mean age of 64.1 years [SD 11.9], 7154 [75%] men), over half (5119 [53.5%] had multimorbidities. LCA identified 3 multimorbidity clusters which were severe multimorbidity (591; 6.5%) with low HRQoL at baseline (EQVAS 59.39 and EQ5D 0.62) which did not improve significantly at 6 months (EQVAS 59.92, EQ5D 0.60); moderate multimorbidity (4301; 47.6%) with medium HRQoL at baseline (EQVAS 63.08, EQ5D 0.71) and who improved at 6 months (EQVAS 71.38, EQ5D 0.76); and mild multimorbidity (4147, 45.9%) at baseline (EQVAS 64.57, EQ5D 0.75) and improved at 6 months (EQVAS 76.39, EQ5D 0.82). Patients in the severe and moderate groups were more likely to be older, women, and presented with NSTEMI. Compared with the mild group, increased multimorbidity was associated with lower EQ-VAS scores (adjusted coefficient: -5.12 [95% CI -7.04 to -3.19] and -0.98 [-1.93 to -0.04] for severe and moderate multimorbidity, respectively. The severe class was more likely than the mild class to report problems in mobility, OR 9.62 (95% confidence interval: 6.44 to 14.36), self-care 7.87 (4.78 to 12.97), activities 2.41 (1.79 to 3.26), pain 2.04 (1.50 to 2.77), and anxiety/depression 1.97 (1.42 to 2.74). CONCLUSIONS Among MI survivors, multimorbidity clustered into three distinct patterns and was inversely associated with HRQoL. The identified multimorbidity patterns and HRQoL domains that are mostly affected may help to identify patients at risk of poor HRQoL for which clinical interventions could be beneficial to improve the HRQoL of MI survivors. TRIAL REGISTRATION ClinicalTrials.gov NCT01808027 and NCT01819103.
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Affiliation(s)
- T Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK. .,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
| | - T B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - S Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Wilkinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - M Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - B Hurdus
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - R M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - A S Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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6
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Hurdus B, Munyombwe T, Dondo TB, Aktaa S, Oliver G, Hall M, Doherty P, Hall AS, Gale CP. Association of cardiac rehabilitation and health-related quality of life following acute myocardial infarction. Heart 2020; 106:1726-1731. [PMID: 32826289 PMCID: PMC7656151 DOI: 10.1136/heartjnl-2020-316920] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To study the association of cardiac rehabilitation and physical activity with temporal changes in health-related quality of life (HRQoL) following acute myocardial infarction (AMI). METHODS Evaluation of the Methods and Management of Acute Coronary Events-3 is a nationwide longitudinal prospective cohort study of 4570 patients admitted with an AMI between 1 November 2011 and 17 September 2013. HRQoL was estimated using EuroQol 5-Dimension-3 Level Questionnaire at hospitalisation, 30 days, and 6 and 12 months following hospital discharge. The association of cardiac rehabilitation and self-reported physical activity on temporal changes in HRQoL was quantified using inverse probability of treatment weighting propensity score and multilevel regression analyses. RESULTS Cardiac rehabilitation attendees had higher HRQoL scores than non-attendees at 30 days (mean EuroQol 5-Visual Analogue Scale (EQ-VAS) scores: 71.0 (SD 16.8) vs 68.6 (SD 19.8)), 6 months (76.0 (SD 16.4) vs 70.2 (SD 19.0)) and 12 months (76.9 (SD 16.8) vs 70.4 (SD 20.4)). Attendees who were physically active ≥150 min/week had higher HRQoL scores compared with those who only attended cardiac rehabilitation at 30 days (mean EQ-VAS scores: 79.3 (SD 14.6) vs 70.2 (SD 17.0)), 6 months (82.2 (SD 13.9) vs 74.9 (SD 16.7)) and 12 months (84.1 (SD 12.1) vs 75.6 (SD 17.0)). Cardiac rehabilitation and self-reported physical activity of ≥150 min/week were each positively associated with temporal improvements in HRQoL (coefficient: 2.12 (95% CI 0.68 to 3.55) and 4.75 (95% CI 3.16 to 6.34), respectively). CONCLUSIONS Cardiac rehabilitation was independently associated with temporal improvements in HRQoL at up to 12 months following hospitalisation, with such changes further improved in patients who were physically active.
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Affiliation(s)
- Ben Hurdus
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Theresa Munyombwe
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | | | - Suleman Aktaa
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Marlous Hall
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - Patrick Doherty
- Health Sciences, University of York, York, North Yorkshire, UK
| | - Alistair S Hall
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Munyombwe T, Hall M, Dondo TB, Alabas OA, Gerard O, West RM, Pujades-Rodriguez M, Hall A, Gale CP. Quality of life trajectories in survivors of acute myocardial infarction: a national longitudinal study. Heart 2020; 106:33-39. [PMID: 31699696 DOI: 10.1136/heartjnl-2019-315510] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/09/2019] [Accepted: 08/21/2019] [Indexed: 11/04/2022] Open
Abstract
AIM To define trajectories of perceived health-related quality of life (HRQoL) among survivors of acute myocardial infarction (AMI) and identify factors associated with trajectories. METHODS Data on HRQoL among 9566 survivors of AMI were collected from 77 National Health Service hospitals in England between 1 November 2011 and 24 June 2015. Longitudinal HRQoL was collected using the EuroQol five-dimension questionnaire measured at hospitalisation, 1, 6 and 12 months post-AMI. Trajectories of perceived HRQoL post-MI were determined using multilevel regression analysis and latent class growth analysis (LCGA). RESULTS One or more percieved health problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression was reported by 69.1% (6607/9566) at hospitalisation and 59.7% (3011/5047) at 12 months. Reduced HRQoL was associated with women (-4.07, 95% CI -4.88 to -3.25), diabetes (-2.87, 95% CI -3.87 to -1.88), previous AMI (-1.60, 95% CI -2.72 to -0.48), previous angina (-1.72, 95% CI -2.77 to -0.67), chronic renal failure (-2.96, 95% CI -5.08 to -0.84; -3.10, 95% CI -5.72 to -0.49), chronic obstructive pulmonary disease (-3.89, 95% CI -5.07 to -2.72) and cerebrovascular disease (-2.60, 95% CI -4.24 to -0.96). LCGA identified three subgroups of HRQoL which we labelled: improvers (68.1%), non-improvers (22.1%) and dis-improvers (9.8%). Non-improvers and dis-improvers were more likely to be women, non-ST-elevation myocardial infarction (NSTEMI) and have long-term health conditions, compared with improvers. CONCLUSIONS Quality of life improves for the majority of survivors of AMI but is significantly worse and more likely to decline for women, NSTEMI and those with long-term health conditions. Assessing HRQoL both in hospital and postdischarge may be important in determining which patients could benefit from tailored interventions. TRIAL REGISTRATION NCT01808027 and NCT01819103.
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Affiliation(s)
- Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Tatendashe Bernadette Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Oras A Alabas
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Oliver Gerard
- National Health Service cardiac service user, West Yorkshire, Lancashire, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Alistair Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
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Dondo TB, Hall M, Munyombwe T, Wilkinson C, Yadegarfar ME, Timmis A, Batin PD, Jernberg T, Fox KA, Gale CP. A nationwide causal mediation analysis of survival following ST-elevation myocardial infarction. Heart 2019; 106:765-771. [PMID: 31732655 PMCID: PMC7229897 DOI: 10.1136/heartjnl-2019-315760] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 01/22/2023] Open
Abstract
Objective International studies report a decline in mortality following ST-elevation myocardial infarction (STEMI). The extent to which the observed improvements in STEMI survival are explained by temporal changes in patient characteristics and utilisation of treatments is unknown. Methods Cohort study using national registry data from the Myocardial Ischaemia National Audit Project between first January 2004 and 30th June 2013. 232 353 survivors of hospitalisation with STEMI as recorded in 247 hospitals in England and Wales. Flexible parametric survival modelling and causal mediation analysis were used to estimate the relative contribution of temporal changes in treatments and patient characteristics on improved STEMI survival. Results Over the study period, unadjusted survival at 6 months and 1 year improved by 0.9% and 1.0% on average per year (HR: 0.991, 95% CI: 0.988 to 0.994 and HR: 0.990, 95% CI: 0.987 to 0.993, respectively). The uptake of primary percutaneous coronary intervention (PCI) (HR: 1.025, 95% CI: 1.021 to 1.028) and increased prescription of P2Y12 inhibitors (HR: 1.035, 95% CI: 1.031 to 1.039) were significantly associated with improvements in 1-year survival. Primary PCI explained 16.8% (95% CI: 10.8% to 31.6%) and 13.2% (9.2% to 21.9%) of the temporal survival improvements at 6 months and 1 year, respectively, whereas P2Y12 inhibitor prescription explained 5.3% (3.6% to 8.8%) of the temporal improvements at 6 months but not at 1 year. Conclusions For STEMI in England and Wales, improvements in survival between 2004 and 2013 were significantly explained by the uptake of primary PCI and increased use of P2Y12 inhibitors at 6 months and primary PCI only at 1 year. Trial registration number NCT03749694
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Affiliation(s)
- Tatendashe Bernadette Dondo
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Marlous Hall
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Theresa Munyombwe
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Wilkinson
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Mohammad E Yadegarfar
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Adam Timmis
- NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust, London, UK
| | - Philip D Batin
- Department of Cardiology, Pinderfields General Hospital, Wakefield, UK
| | - Tomas Jernberg
- Department of Medicine, Section of Cardiology, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Keith Aa Fox
- Department of Cardiology, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chris P Gale
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Zusman O, Bebb O, Hall M, Dondo TB, Timmis A, Schiele F, Fox KAA, Kornowski R, Gale CP, Iakobishvili Z. International comparison of acute myocardial infarction care and outcomes using quality indicators. Heart 2019; 105:820-825. [DOI: 10.1136/heartjnl-2018-314197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo compare temporal changes in European Society of Cardiology (ESC) acute myocardial infarction (AMI) quality indicator (QI) attainment in the UK and Israel.MethodsData cross-walking using information from the Myocardial Ischaemia National Audit Project and the Acute Coronary Syndrome in Israel Survey for matching 2-month periods in 2006, 2010 and 2013 was used to compare country-specific attainment of 14 ESC AMI QIs.ResultsPatients in the UK (n=17 068) compared with Israel (n=5647) were older, more likely to be women, and had less diabetes, dyslipidaemia and heart failure. Baseline ischaemic risk was lower in Israel than the UK (Global Registry of Acute Coronary Events (GRACE) risk, 110.5 vs 121.0). Overall, rates of coronary angiography (87.6% vs 64.8%) and percutaneous coronary intervention (70.3% vs 41.0%) were higher in Israel compared with the UK. Composite QI performance increased more in the UK (1.0%–86.0%) than Israel (70.2%–78.0%). Mortality rates at 30 days declined in each country, with lower rates in Israel in 2013 (4.2% vs 7.6%). Composite QI adherence adjusted for GRACE risk score was inversely associated with 30-day mortality (OR 0.95; CI 0.95 to 0.97, p<0.001).ConclusionsInternational comparisons of guideline recommended AMI care and outcomes can be quantified using the ESC AMI QIs. International implementation of the ESC AMI QIs may reveal country-specific opportunities for improved healthcare delivery.
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Alabas OA, Hall M, Dondo TB, Rutherford MJ, Timmis AD, Batin PD, Deanfield JE, Hemingway H, Gale CP. Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study. J Epidemiol Community Health 2017; 71:25-32. [PMID: 27307468 DOI: 10.1136/jech-2016-207402] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/20/2016] [Accepted: 05/25/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The long-term excess risk of death associated with diabetes following acute myocardial infarction is unknown. We determined the excess risk of death associated with diabetes among patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) after adjustment for comorbidity, risk factors and cardiovascular treatments. METHODS Nationwide population-based cohort (STEMI n=281 259 and NSTEMI n=422 661) using data from the UK acute myocardial infarction registry, MINAP, between 1 January 2003 and 30 June 2013. Age, sex, calendar year and country-specific mortality rates for the populace of England and Wales (n=56.9 million) were matched to cases of STEMI and NSTEMI. Flexible parametric survival models were used to calculate excess mortality rate ratios (EMRR) after multivariable adjustment. This study is registered at ClinicalTrials.gov (NCT02591576). RESULTS Over 1.94 million person-years follow-up including 120 568 (17.1%) patients with diabetes, there were 187 875 (26.7%) deaths. Overall, unadjusted (all cause) mortality was higher among patients with than without diabetes (35.8% vs 25.3%). After adjustment for age, sex and year of acute myocardial infarction, diabetes was associated with a 72% and 67% excess risk of death following STEMI (EMRR 1.72, 95% CI 1.66 to 1.79) and NSTEMI (1.67, 1.63 to 1.71). Diabetes remained significantly associated with substantial excess mortality despite cumulative adjustment for comorbidity (EMRR 1.52, 95% CI 1.46 to 1.58 vs 1.45, 1.42 to 1.49), risk factors (1.50, 1.44 to 1.57 vs 1.33, 1.30 to 1.36) and cardiovascular treatments (1.56, 1.49 to 1.63 vs 1.39, 1.36 to 1.43). CONCLUSIONS At index acute myocardial infarction, diabetes was common and associated with significant long-term excess mortality, over and above the effects of comorbidities, risk factors and cardiovascular treatments.
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Affiliation(s)
- O A Alabas
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - M Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - T B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - M J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A D Timmis
- The National Institute for Health Biomedical Research Unit, Barts Health, London, UK
| | - P D Batin
- Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - J E Deanfield
- National Institute for Cardiovascular Outcomes Research, University College London, London, UK
| | - H Hemingway
- The Farr Institute, University College London, London, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- York Teaching Hospital NHS Foundation Trust, York, UK
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11
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Dondo TB, Hall M, Timmis AD, Yan AT, Batin PD, Oliver G, Alabas OA, Norman P, Deanfield JE, Bloor K, Hemingway H, Gale CP. Geographic variation in the treatment of non-ST-segment myocardial infarction in the English National Health Service: a cohort study. BMJ Open 2016; 6:e011600. [PMID: 27406646 PMCID: PMC4947744 DOI: 10.1136/bmjopen-2016-011600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate geographic variation in guideline-indicated treatments for non-ST-elevation myocardial infarction (NSTEMI) in the English National Health Service (NHS). DESIGN Cohort study using registry data from the Myocardial Ischaemia National Audit Project. SETTING All Clinical Commissioning Groups (CCGs) (n=211) in the English NHS. PARTICIPANTS 357 228 patients with NSTEMI between 1 January 2003 and 30 June 2013. MAIN OUTCOME MEASURE Proportion of eligible NSTEMI who received all eligible guideline-indicated treatments (optimal care) according to the date of guideline publication. RESULTS The proportion of NSTEMI who received optimal care was low (48 257/357 228; 13.5%) and varied between CCGs (median 12.8%, IQR 0.7-18.1%). The greatest geographic variation was for aldosterone antagonists (16.7%, 0.0-40.0%) and least for use of an ECG (96.7%, 92.5-98.7%). The highest rates of care were for acute aspirin (median 92.8%, IQR 88.6-97.1%), and aspirin (90.1%, 85.1-93.3%) and statins (86.4%, 82.3-91.2%) at hospital discharge. The lowest rates were for smoking cessation advice (median 11.6%, IQR 8.7-16.6%), dietary advice (32.4%, 23.9-41.7%) and the prescription of P2Y12 inhibitors (39.7%, 32.4-46.9%). After adjustment for case mix, nearly all (99.6%) of the variation was due to between-hospital differences (median 64.7%, IQR 57.4-70.0%; between-hospital variance: 1.92, 95% CI 1.51 to 2.44; interclass correlation 0.996, 95% CI 0.976 to 0.999). CONCLUSIONS Across the English NHS, the optimal use of guideline-indicated treatments for NSTEMI was low. Variation in the use of specific treatments for NSTEMI was mostly explained by between-hospital differences in care. Performance-based commissioning may increase the use of NSTEMI treatments and, therefore, reduce premature cardiovascular deaths. TRIAL REGISTRATION NUMBER NCT02436187.
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Affiliation(s)
- T B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - M Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - A D Timmis
- The National Institute for Health Biomedical Research Unit, Barts Health, London, UK
| | - A T Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - P D Batin
- Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - G Oliver
- National Health Service cardiac service user, West Yorkshire, UK
| | - O A Alabas
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - P Norman
- School of Geography, University of Leeds, Leeds, UK
| | - J E Deanfield
- National Institute for Cardiovascular Outcomes Research, University College London, London, UK
| | - K Bloor
- Department of Health Sciences, University of York, York, UK
| | - H Hemingway
- The Farr Institute, University College London, London, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
- York Teaching Hospital NHS Foundation Trust, York, UK
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12
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Alabas OA, Brogan RA, Hall M, Almudarra S, Rutherford MJ, Dondo TB, Feltbower R, Curzen N, de Belder M, Ludman P, Gale CP. Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention. Heart 2016; 102:1287-95. [PMID: 27056968 DOI: 10.1136/heartjnl-2015-308739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Received: 09/23/2015] [Accepted: 03/09/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality. METHODS A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI-CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56.6 million people. Relative survival and excess mortality were estimated. RESULTS Over 26 105 person-years follow-up, crude 5-year relative survival was 93.8% for CSA, 73.1% for NSTEACS, 77.5% for STEMI-CS and 28.5% for STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73, 95% CI 4.06 to 11.15), and for NSTEACS and STEMI-CS was preprocedural ventilation (6.25, 5.05 to 7.75 and 6.92, 4.25 to 11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural thrombolysis in myocardial infarction (TIMI) 0 flow (2.78, 1.87 to 4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61 to 0.90). CONCLUSIONS Long-term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI-CS, the requirement for preprocedural ventilation was the strongest determinant of excess mortality. By contrast, among STEMI+CS, in whom survival was poor, the strongest determinant was preprocedural TIMI flow. Future cardiovascular cohort studies of long-term mortality should consider the impact of non-cardiovascular deaths.
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Affiliation(s)
- O A Alabas
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - R A Brogan
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - M Hall
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - S Almudarra
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - M J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - T B Dondo
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - R Feltbower
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - N Curzen
- Department of Cardiology, University Hospital Southampton NHS FT & Faculty of Medicine, University of Southampton, Southampton, UK
| | - M de Belder
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, UK
| | - P Ludman
- Department of Cardiology Queen Elizabeth Hospital, Birmingham, UK
| | - C P Gale
- MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
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Hall M, Laut K, Dondo TB, Alabas OA, Brogan RA, Gutacker N, Cookson R, Norman P, Timmis A, de Belder M, Ludman PF, Gale CP. Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003-2013. Heart 2016; 102:313-319. [PMID: 26732182 PMCID: PMC4752647 DOI: 10.1136/heartjnl-2015-308616] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation. METHODS Whole country registry data (MINAP, Myocardial Ischaemia National Audit Project) comprising PPCI-capable National Health Service trusts in England (84 hospital trusts; 92 350 hospitalisations; 90 489 patients), 2003-2013. Multilevel Poisson regression modelled the relationship between incidence rate ratios (IRR) of PPCI and patient and trust-level factors. RESULTS Overall, standardised rates of PPCI increased from 0.01% to 86.3% (2003-2013). While, on average, there was a yearly increase in PPCI utilisation of 30% (adjusted IRR 1.30, 95% CI 1.23 to 1.36), it varied substantially between trusts. PPCI rates were lower for patients with previous myocardial infarction (0.95, 0.93 to 0.98), heart failure (0.86, 0.81 to 0.92), angina (0.96, 0.94 to 0.98), diabetes (0.97, 0.95 to 0.99), chronic renal failure (0.89, 0.85 to 0.90), cerebrovascular disease (0.96, 0.93 to 0.99), age >80 years (0.87, 0.85 to 0.90), and travel distances >30 km (0.95, 0.93 to 0.98). PPCI rates were higher for patients with previous percutaneous coronary intervention (1.09, 1.05 to 1.12) and among trusts with >5 interventional cardiologists (1.30, 1.25 to 1.34), more visiting interventional cardiologists (1-5: 1.31, 1.26 to 1.36; ≥6: 1.42, 1.35 to 1.49), and a 24 h, 7-days-a-week PPCI service (2.69, 2.58 to 2.81). Half of the unexplained variation in PPCI rates was due to between-trust differences. CONCLUSIONS Following an 8 year implementation phase, PPCI utilisation rates stabilised at 85%. However, older and sicker patients were less likely to receive PPCI and there remained between-trust variation in PPCI rates not attributable to differences in staffing levels. Compliance with clinical pathways for STEMI is needed to ensure more equitable quality of care.
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Affiliation(s)
- M Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - K Laut
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - T B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - O A Alabas
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - R A Brogan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK York Teaching Hospital NHS Foundation Trust, York, UK
| | - N Gutacker
- Centre for Health Economics, University of York, York, UK
| | - R Cookson
- Centre for Health Economics, University of York, York, UK
| | - P Norman
- School of Geography, University of Leeds, Leeds, UK
| | - A Timmis
- NIHR Biomedical Research Unit at Barts Health, Queen Mary University, London, UK
| | - M de Belder
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - P F Ludman
- Queen Elizabeth Hospital, Birmingham, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK York Teaching Hospital NHS Foundation Trust, York, UK
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