Journal Cover European Heart Journal - Quality of Care and Clinical Outcomes
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2058-5225 - ISSN (Online) 2058-1742
   Published by Oxford University Press Homepage  [370 journals]
  • The obesity paradox and obesity severity in elderly STEMI patients
    • Authors: Lavie CJ; Oktay A, Milani RV.
      Abstract: Overweight and obesity have been increasing in prevalence and have reached epidemic levels not only in the United States (US) but also in much of the Westernized world.1,2 In fact, based on reports from 2013 to 2014, the prevalence of obesity [body mass index (BMI) of ≥30 kg/m2] in the US has reached 38%, and severe or Class III obesity (BMI ≥ 40 kg/m2) is approaching 8%, which places a ‘heavy’ burden on the overall and, particularly, cardiovascular (CV) health of the population.2
      PubDate: 2017-07-17
  • Corrigendum
    • Abstract: Corrigendum to: Cardio-oncology – Editorial on management and outcomes of patients with atrial fibrillation and a history of cancer: the ORBIT-AF registry
      PubDate: 2017-06-29
  • Revsacularization for unprotected left main coronary artery disease: has
           stenting caught up with bypass surgery'
    • Authors: Archbold R.
      Abstract: This editorial refers to ‘Percutaneous coronary intervention versus coronary artery bypass grafting for left main revascularization: an updated meta-analysis’, by N. S. Bajaj et al. on page 173.
      PubDate: 2017-06-12
  • Regional differences in coronary revascularization procedures and
           outcomes: a nationwide 11-year observational study
    • Authors: Vaez M; Dalén M, Friberg Ö, et al.
      Abstract: AbstractAimsThe study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden.Methods and resultsWe conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients, while repeat PCI was performed more frequently in the PCI group. CABG proportions in 21 counties ranged from 13% to 42% in females and males. The combined outcomes of repeat revascularization, non-fatal acute myocardial infarction, and death during the tracking period was recorded in 151 936 patients without ST-elevation myocardial infarction after PCI (n = 37 820, 36%) and CABG (n = 18 903, 40%). The multivariable adjusted risk of combined outcomes was higher after both PCI and CABG in both females and males in the three quartiles of counties with a smaller proportion of CABG than in the quartile of counties with the highest proportion of CABG. Similar patterns persisted after including only mortality in the analyses.ConclusionThere are subgroups of patients who have prognostic benefits of CABG in addition to symptomatic improvement that is well documented with both PCI and CABG.
      PubDate: 2017-04-29
  • The obesity paradox, extreme obesity, and long-term outcomes in older
           adults with ST-segment elevation myocardial infarction: results from the
    • Authors: Neeland IJ; Das SR, Simon DN, et al.
      Abstract: AbstractAimsTo investigate the obesity paradox and association of extreme obesity with long-term outcomes among older ST-segment elevation myocardial infarction (STEMI) patients.Methods and resultsNineteen thousand four hundred and ninety-nine patients ≥65 years with STEMI surviving to hospital discharge in NCDR ACTION Registry-GWTG linked to Centers for Medicare and Medicaid Services outcomes between 2007 and 2012 were stratified by body mass index (BMI) (kg/m2) into normal weight (18.5–24.9), overweight (25–29.9), class I (30–34.9), class II (35–39.9), and class III/extreme obese (≥40) categories. Multivariable-adjusted associations were evaluated between BMI categories and mortality by Cox proportional hazards models, and days alive and out of hospital (DAOH) by generalized estimating equations, within 3 years after discharge. Seventy percent of patients were overweight/obese and 3% extremely obese. Normal weight patients were older and more likely to smoke; while extremely obese patients were younger and more likely to be female and black, with lower socioeconomic status and more comorbidity (P ≤ 0.001). A U-shaped association was observed between BMI categories and mortality: patients with class I obesity were at lowest risk, while normal weight [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.15–1.47] and extremely obese patients (HR 1.33, 95% CI 1.02–1.74) had higher mortality. Normal weight [odds ratio (OR) 0.79, 95% CI 0.68–0.90] and extremely obese (OR 0.73, 95% CI 0.54–0.99) individuals also had lower odds of DAOH.ConclusionMild obesity is associated with lower long-term risk in older STEMI patients, while normal weight and extreme obesity are associated with worse outcomes. These findings highlight hazards faced by an increasing number of older individuals with normal weight or extreme obesity and cardiovascular disease.
      PubDate: 2017-04-03
  • Sex differences in post-traumatic stress disorder in cardiovascular
           patients after the Great East Japan Earthquake: a report from the CHART-2
    • Authors: Onose T; Sakata Y, Nochioka K, et al.
      Abstract: AbstractAimsThe temporal changes and sex differences in post-traumatic stress disorder (PTSD) after natural disasters remain unclear. Therefore, we examined the prevalence, prognostic impacts, and determinant factors of PTSD after the Great East Japan Earthquake (GEJE) of 11 March 2011 in cardiovascular (CV) patients registered in the Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-2 Study (n = 10 219), with a special reference to sex.Methods and resultsBy self-completion questionnaires of the Japanese-language version of the Impact of Event Scale–Revised (IES-R-J), the prevalence of PTSD, defined as IES-R-J score ≥25, was 14.8, 15.7, 7.4, and 7.5% in 2011, 2012, 2013, and 2014, respectively. The PTSD rate was higher in women than in men in all years (all P < 0.01). During a median 3.5-year follow-up period, the patients with PTSD in 2011 more frequently experienced a composite of all-cause death and hospitalization for acute myocardial infarction, stroke, and heart failure than those without PTSD [adjusted hazard ratio (aHR) 1.27, P < 0.01]. Importantly, the prognostic impacts of PTSD on all-cause death (aHR 2.10 vs. 0.87, P for interaction = 0.03) and CV death (aHR 3.43 vs. 0.90, P for interaction = 0.02) were significant in women but not in men. While insomnia medication was a prominent determinant factor of PTSD in both sexes during 2011–14, economic poverty was significantly associated with PTSD only in men.ConclusionAfter the GEJE, marked sex differences existed in the prevalence, prognostic impacts, and determinant factors of PTSD, suggesting the importance of sex-sepcific mental stress care in disaster medicine.
      PubDate: 2017-04-03
  • Percutaneous coronary intervention vs. coronary artery bypass grafting for
           left main revascularization: an updated meta-analysis
    • Authors: Bajaj NS; Patel N, Kalra R, et al.
      Abstract: AbstractAimsThe optimal revascularization strategy for left main coronary artery disease (LMD) remains controversial, especially with two recent randomized controlled trials showing conflicting results. We sought to address this controversy with our analysis.Methods and resultsComprehensive literature search was performed. We compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for LMD revascularization using standard meta-analytic techniques. A 21% higher risk of long-term major adverse cardiac and cerebrovascular event [MACCE; composite of death, myocardial infarction (MI), stroke, and repeat revascularization] was observed in patients undergoing PCI in comparison with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05–1.40]. This risk was driven by higher rate of repeat revascularization in those undergoing PCI (RR 1.61, 95% CI 1.34–1.95). On the contrary, MACCE rates at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI 0.39–0.76), which was driven by lower rates of stroke in the PCI arm (RR 0.41, 95% CI 0.17–0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI 0.08–0.59) in the PCI arm were balanced by higher repeat revascularization rates in those undergoing PCI (RR 1.78, 95% CI 1.33–2.37), resulting in a clinical equipoise in MACCE rates between the two revascularization strategies. There was no difference in death or MI between PCI when compared with CABG at any time point.ConclusionOutcomes of CABG vs. PCI for LMD revascularization vary over time. Therefore, individualized decisions need to be made for LMD revascularization using the heart team approach.
      PubDate: 2017-03-31
  • Myocardial infarction in pregnancy: how frequent, how fatal'
    • Authors: Regitz-Zagrosek V.
      Abstract: Young women, at an age when they may become pregnant, nowadays exhibit an increasing number of risk factors for cardiovascular disease, particularly acute myocardial infarction (AMI). Hypertension, obesity, hyperlipidaemia, diabetes, and smoking rates are increasing in women in Western societies and daily physical exercise is much underused. Thus, risk profiles for AMI in the USA and Europe are rising in women of childbearing age and are further exaggerated by contemporary trends for pregnancy later in life.1,2 Nevertheless, AMI during pregnancy remains rare and was estimated to occur in only 3 to 6 deliveries per 100 000 in recent ESC guidelines.3–6 Pregnancy-related AMI (PAMI) can occur at any stage of gestation. It is strongly related to the major coronary risk factors listed above, with other pregnancy-related disorders such as (pre-)eclampsia, thrombophilia, post-partum infections, and severe post-partum haemorrhage further contributing to the risk.5–8 Recently, attention has been given to the role of spontaneous coronary dissections (sCAD),3,9 which are more prevalent among pregnant women than non-pregnant women and are mostly reported around delivery or in the early post-partum period.5 They may be related to high progesterone levels causing structural changes in the collagen of the vessel wall. Ergometrine given for post-partum bleeding has also been implicated in the pathophysiology of PAMI by stimulation of coronary vasospasm and ischaemia.5
      PubDate: 2017-03-21
  • Are there sex differences following treatment of left ventricular outflow
           tract obstruction in adults with hypertrophic cardiomyopathy'
    • Authors: Chahal AA; Alhurani RE, Mohamed EA, et al.
      Abstract: Hypertrophic obstructive cardiomyopathy (HOCM) is the most common inherited cardiomyopathy, affecting approximately 1 in 500 individuals. The male predominance of the condition varies from 51% to 91%, suggesting other factors (i.e. environment, sex hormones, and epigenetics) affect the phenotype.1 Women with HOCM tend to be more symptomatic, present later in life, are more likely to have left ventricular outflow tract obstruction, and have greater mortality when < 50 years of age.2 Because the selection of treatment is based on symptom presentation, it is unclear if there is a sex bias in applying the criteria and/or outcomes independent of selection bias, and whether females’ benefit more from a particular therapy. Thus, an a priori protocol to determine if there were sex differences in selection of treatment and outcomes for HOCM was created for a systematic review to predefine population criteria, description of interventions, and comparisons of the outcomes of interest of three treatments for HOCM: surgical myectomy (SM), alcohol septal ablation (ASA), and dual chamber pacing (DDD) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).3 Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus) were searched for studies of a minimum of 5 adults who underwent SM, ASA, or DDD as a primary procedure from inception in 1946 to 30 December 2015. The detailed search strategy, list of studies included and discussion are reported in the Supplementary material onlineSupplementary material online.
      PubDate: 2017-03-13
  • Management and outcomes of patients with atrial fibrillation and a history
           of cancer: the ORBIT-AF registry
    • Authors: Melloni C; Shrader P, Carver J, et al.
      Abstract: AbstractAimsThe presence of cancer can complicate treatment choices for patients with atrial fibrillation (AF) increasing both the risk of thrombotic and bleeding events.Methods and resultsUsing data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we aimed to characterize AF patients with cancer, to describe their management and to assess the association between cancer and cardiovascular (CV) outcomes. Among 9749 patients, 23.8% had history of cancer (57% solid malignancy, 1.3% leukaemia, 3.3% lymphoma, 40% other type, and 2.2% metastatic cancer). Patients with history of cancer were older, more likely to have CV disease, CV risk factors, and prior gastrointestinal bleeding. No difference in antiarrhythmic and antithrombotic therapy was observed between those with and without cancer. Patients with history of cancer had a significantly higher risk of death (7.8 vs. 4.9 deaths per 100 patient-years follow-up, P = 0.0003) mainly driven by non-CV death (4.2 vs. 2.4 per 100 patient-years follow-up; P = 0.0004) and higher risk of major bleeding (5.1 vs. 3.5 per 100 patient-years follow-up; P = 0.02) compared with non-cancer patients; no differences were observed in risks of strokes/non-central nervous system embolism (1.96 vs. 1.48, P = 0.74) and CV death (2.89 vs. 2.07, P = 0.35) between the two groups.ConclusionA history of cancer is common among AF patients with up to one in four patients having both. Antithrombotic therapy, rates of cerebrovascular accident, other thrombotic events and cardiac death were similar in AF patients with or without a history of cancer. Patients with cancer, however, were at higher risk of major bleeding and non-CV death.
      PubDate: 2017-03-11
  • Cancer and heart disease: new bedfellows in the cardiovascular landscape
    • Authors: Adlam D; Peake MD.
      Abstract: Clinical medicine and medical research have long occupied disease-specific specialties. A visitor to any hospital or university in a developed country will likely find a cardiology department or an institute of cancer research but frequently these are widely separated or even in different buildings. This is reflected in clinical research where cancer is a frequent exclusion criterion from cardiovascular trials and likewise patients with established heart disease are often routinely excluded from cancer studies. As a result our understanding of how cancer, cardiovascular disease and their treatments interact remains relatively limited. This is despite the fact that improved treatments for both conditions have resulted in substantially improved survival rates and as a result, an ever larger population of patients will now experience both conditions in their lifetime.
      PubDate: 2017-02-21
  • Quality of life following coronary artery bypass graft surgery vs.
           percutaneous coronary intervention in diabetics with multivessel disease:
           a five-year registry study
    • Authors: McGrath BM; Norris CM, Hardwicke-Brown E, et al.
      Abstract: AbstractAimsThe aim of this study is to investigate the long-term relationship between revascularization technique and health status in diabetics with multivessel disease.Methods and resultsUsing the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, we captured 1319 diabetics with multivessel disease requiring revascularization for an acute coronary syndrome (January 2009–December 2012) and reported health status using the Seattle Angina Questionnaire (SAQ) at baseline, 1, 3 and 5-years [599 underwent coronary artery bypass grafting (CABG); 720 underwent percutaneous coronary intervention (PCI)]. Adjusted analyses were performed using a propensity score-matching technique. After adjustment (including baseline SAQ domain scores), 1-year mean (95% CI) SAQ scores (range 0–100 with higher scores reflecting improved health status) were significantly greater in selected domains for CABG compared to PCI (exertional capacity: 81.7 [79.5–84.0] vs. 78.8 [76.5–81.0], P = 0.07; angina stability: 83.1 [80.4–85.9] vs. 75.0 [72.3–77.8], P < 0.001]; angina frequency 93.2 [91.6–95.0] vs. 90.0 [87.8–91.3], P = 0.003; treatment satisfaction: 93.6 [92.2–94.9] vs. 90.8 [89.2–92.0], P = 0.003; quality of life [QOL]: 83.8 [81.7–85.8] vs. 77.2 [75.2–79.2] P < 0.001). At 3-years, these benefits were attenuated (exertional capacity: 79.3 [76.9–81.7] vs. 78.7 [76.3–81.1], P = 0.734; angina stability 79.3 [76.3–82.3] vs. 75.5 [72.5–78.5], P = 0.080; angina frequency: 93.2 [91.3–95.1] vs. 90.9 [89.0–92.8], P = 0.095; treatment satisfaction: 92.5 [91.0–94.0] vs. 91.5 [90.0–93.0] P = 0.382; QOL: 83.2 [81.1–85.2] vs. 80.3 [78.2–82.4], P = 0.057). At 5-years, majority of domains were similar (exertional capacity: 77.8 [75.0–80.6] vs. 76.3 [73.2–79.3], P = 0.482; angina stability: 78.0 [74.8–81.2] vs. 74.8 [71.4–78.2], P = 0.175; angina frequency: 94.2 [92.3–96.0] vs. 90.9 [89.0–92.9], P = 0.018; treatment satisfaction: 93.7 [92.2–95.1] vs. 92.2 [90.6–93.7], P = 0.167; QOL: 84.1 [82.0–86.3] vs. 81.1 [78.8–83.4], P = 0.058). Majority in both groups remained angina-free at 5-years (75.0% vs. 70.3%, P = 0.15).ConclusionImprovements in health status with CABG compared with PCI were not sustained long-term. This temporal sequence should be considered when contemplating a revascularization strategy in diabetics with multivessel disease.
      PubDate: 2017-01-20
  • Incidence of myocardial infarction in pregnancy: a systematic review and
           meta-analysis of population-based studies
    • Authors: Gibson P; Narous M, Firoz T, et al.
      Abstract: AbstractAimsCardiac disease is one of the leading causes of indirect maternal death, and myocardial infarction (MI) is one of its most common aetiologies. The objectives of this systematic review and meta-analysis were to characterize the incidence of pregnancy-associated MI (PAMI), as well as the maternal mortality and the case-fatality rates due to PAMI.Methods and resultsArticles were obtained by searching electronic databases, bibliographies and conference proceedings with no language or date restrictions. Two reviewers independently selected population-based cohort and case-control studies reporting on incidence, mortality and case-fatality rates for pregnancy-associated MI. Meta-analysis was performed to estimate pooled maternal incidence, mortality and case-fatality rates. Meta-regression was performed to explore heterogeneity. Based on 17 included studies, the pooled incidence of PAMI and maternal mortality from PAMI were 3.34 (2.09–4.58) and 0.20 (0.10–0.29) per 100 000 pregnancies, respectively. The case-fatality rate was 5.03% (3.78–6.27%). Country/region (meta-regression P = 0.006) and years of study (meta-regression P = 0.04) were potential explanations for the observed heterogeneity in the pooled incidence estimates of maternal MI and its associated mortality, with more recent studies and those conducted in the USA revealing the highest rates.ConclusionThis article provides a global estimate of the incidence, mortality rate, and case fatality rate of pregnancy-associated MI. We identified higher rates of PAMI in the USA (relative to Canada and European countries) and rising rates over time. Further research regarding this population is needed, especially given rising maternal age and the increasing prevalence of cardiovascular risk factors.
      PubDate: 2017-01-05
  • Long-term survival and fate of the leg in de novo intermittent
    • Authors: Kumakura H; Kanai H, Hojo Y, et al.
      Abstract: AbstractAimsThe long-term life expectancy and fate of the leg, including progression rate to critical limb ischaemia (CLI), were analysed in de novo patients with intermittent claudication (IC).Methods and resultsA prospective cohort study was performed in 1107 patients with de novo IC. The endpoints were overall survival (OS), freedom from major adverse cardiovascular events (MACE), freedom from major adverse cardiovascular and limb events (MACLE), and fate of the leg. The 5-, 10-, 15-, and 20-year rates were 73.3, 47.8, 28.1, and 14.9% for OS, and 63.0, 35.6, 18.5, and 5.7% for freedom from MACE, respectively. In Cox multivariable analysis, body mass index, diabetes, haemodialysis, and C-reactive protein (CRP) level were correlated with OS (P < 0.05). Ankle brachial pressure index, diabetes, coronary artery disease, haemodialysis, and CRP level were independently correlated with freedom from MACE and MACLE. Statins improved mortality, MACE, and MACLE (P < 0.05). Revascularization did not improve mortality and MACE, and femoropopliteal revascularization increased MACLE (P < 0.05). There was no deterioration of claudication in 881 patients (79.6%). Worsening claudication was noted in 211 patients (14.8% per 5 years), and 15 patients (1.1% per 5 years) worsened to CLI. Diabetes and haemodialysis were independent predictors of CLI. A history of cerebral infarction and femoropopliteal revascularization tended to increase CLI.ConclusionsLife expectancy in patients with IC was poor, but the rate of IC progression to CLI was low. Statins improved mortality and morbidity, revascularization did not improve mortality and MACE, and femoropopliteal revascularization reduced freedom from MACLE with a risk of CLI.
      PubDate: 2016-11-08
  • Comparative analysis of recurrent events after presentation with an index
           myocardial infarction or ischaemic stroke
    • Authors: Yeo K; Zheng H, Chow K, et al.
      Abstract: AbstractAimsAcute myocardial infarction (AMI) and stroke are important causes of mortality and morbidity. Our aims are to determine the comparative epidemiology of AMI and ischaemic stroke; and examine the differences in cardiovascular outcomes or mortality occurring after an AMI or stroke.Methods and resultsThe Singapore National Registry of Diseases Office collects countrywide data on AMI, stroke, and mortality. Index events of AMI and ischaemic stroke between 2007 and 2012 were identified. Patients were then matched for occurrences of subsequent AMI, stroke, or death within 1-year of the index event. There were 33 222 patients with first-ever AMI and 20 982 with first-ever stroke. AMI patients were significantly more likely to be men (66.3% vs. 56.9%), non-Chinese (32.1% vs. 24.1%), and smokers (43.1% vs. 38.6%), but less likely to have hypertension (65.6% vs. 79%) and hyperlipidaemia (61.1% vs. 65.5%), compared with stroke patients. In total 6.8% of the AMI patients had recurrent AMI, whereas 4.8% of the stroke patients had recurrent stroke within 1 year; 31.7% of the AMI patients died, whereas 17.1% of the ischaemic stroke patients died within 1 year. Older age, Malay ethnicity, and diabetes mellitus were statistically significant risk factors for all-cause mortality and for the composite endpoint of AMI, stroke, and all-cause mortality, at 1 year.ConclusionsRisk profiles of patients with AMI and stroke are significantly different. Patients suffer recurrent events in vascular territories similar to the index event. Age and diabetes mellitus are significant predictors of recurrent vascular events and mortality.
      PubDate: 2016-10-15
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