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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 continuing challenge of familial hypercholesterolaemia
    • Authors: Patel R.
      Abstract: This editorial refers to ‘Prediction of cardiovascular risk in patients with familial hypercholesterolaemia’, by G. Villa et al., on page 274.
      PubDate: 2017-08-23
       
  • Now is good, earlier is better
    • Authors: Tobert JA; Preiss D.
      Abstract: This editorial refers to ‘Modelling total coronary heart disease burden and long-term benefit of cholesterol lowering in middle aged men with and without a history of cardiovascular disease’, by C.J. Packard et al., on page 281.
      PubDate: 2017-08-07
       
  • Are non-ST-segment elevation myocardial infarctions missing in China'
    • Authors: Murugiah K; Wang Y, Nuti SV, et al.
      Abstract: AimsST-segment elevation myocardial infarctions (STEMI) in China and other low- and middle-income countries outnumber non-ST-segment elevation myocardial infarctions (NSTEMI). We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics.Methods and resultsWe hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics. Using data from the nationally representative China PEACE-Retrospective AMI Study during 2001, 2006, and 2011, we compared hospital NSTEMI proportion across categories of use of any cardiac biomarker (CK, CK-MB, or troponin) and troponin, as well as across region, location, level, and teaching status. Among 15 416 acute myocardial infarction (AMI) patients, 14% had NSTEMI. NSTEMI patients were older, more likely female, and to have comorbidities. Median hospital NSTEMI proportion in each study year was similar across categories of any cardiac biomarker use, troponin, region, location, level, and teaching status. For instance, in 2011 the NSTEMI proportion at hospitals without troponin testing was 11.2% [inter quartile range (IQR) 4.4–16.7%], similar to those with ≥ 75% troponin use (13.0% [IQR 8.7–23.7%]) (P-value for difference 0.77). Analysed as continuous variables there was no relationship between hospital NSTEMI proportion and proportion biomarker use. With troponin use there was no relationship in 2001 and 2006, but a modest correlation in 2011 (R = 0.16, P = 0.043). Admissions for NSTEMI increased from 0.3/100 000 people in 2001 to 3.3/100 000 people in 2011 (P-value for trend < 0.001).ConclusionSTEMI is the dominant presentation of AMI in China, but the proportion of NSTEMI is increasing. Biomarker use and hospital characteristics did not account for the low NSTEMI rate.Clinical trial registrationwww.clinicaltrials.gov (NCT01624883).
      PubDate: 2017-07-27
       
  • The association of depression at any time to the risk of death following
           coronary artery disease diagnosis
    • Authors: May HT; Horne BD, Knight S, et al.
      Abstract: AimsDepression is a risk factor for cardiovascular (CV) diseases, incident CV events, and mortality. Among individuals who experience a CV diagnosis or event, whether a subsequent diagnosis of depression is associated with a greater risk of mortality is unknown. Among patients with existing coronary artery disease (CAD), this study evaluated the association of a subsequent depression diagnosis with all-cause mortality.Methods and resultsPatients (N = 24 137) who had angiographically determined CAD (stenosis ≥70%) were studied. Depression after CAD diagnosis was determined by International Classification of Diseases codes and evaluated as a time-varying covariate predicting mortality in multivariable Cox hazard regression models to control for patients’ differing lengths of time between CAD diagnosis and depression diagnosis. A total of 3646 (15%) had a depression diagnosis during follow-up. Compared with those without depression, these patients were significantly younger (64 ± 12 vs. 65 ± 12 years), more often female (37% vs. 24%), diabetic (40% vs. 30%), previously diagnosed with depression (26% vs. 5%), and less likely to present with an myocardial infarction (MI) (28% vs. 36%). Death (mean follow-up: 9.7 ± 6.1 years) occurred in 40% of patients (depression: 50% vs. no depression: 38%, P < 0.0001). After adjustment, post-CAD depression was the strongest predictor of death (HR = 2.00, P < 0.0001). This association persisted among subgroups with no prior depression diagnosis (HR = 2.00, P < 0.0001) and by angiography indication: stable angina (HR = 1.84, P < 0.0001), unstable angina (HR = 2.25, P < 0.0001), and MI (HR = 2.09, P < 0.0001).ConclusionA depression diagnosis at any time following CAD diagnosis was associated with a two-fold higher risk of death.
      PubDate: 2017-07-26
       
  • Shifting transcatheter aortic valve implantation to low-risk patients: a
           pilgrimage with no shortcuts
    • Authors: Alfonso F; Trillo R, Moris C.
      Abstract: This editorial refers to ‘Systematic review andmeta-analysis to compare outcomes between intermediate- and high-risk patients undergoing transcatheter aortic valve implantation’, by K. Singh et al., on page 289.
      PubDate: 2017-07-25
       
  • Erratum
    • Authors: Fox K; Gersh B, Traore S, et al.
      Abstract: Erratum to: Evolving quality standards for large-scale registries: the GARFIELD-AF experience
      PubDate: 2017-07-21
       
  • Barriers and facilitators to public access defibrillation in
           out-of-hospital cardiac arrest: a systematic review
    • Authors: Smith CM; Lim Choi Keung SN, Khan MO, et al.
      Abstract: Public access defibrillation initiatives make automated external defibrillators available to the public. This facilitates earlier defibrillation of out-of-hospital cardiac arrest victims and could save many lives. It is currently only used for a minority of cases. The aim of this systematic review was to identify barriers and facilitators to public access defibrillation. A comprehensive literature review was undertaken defining formal search terms for a systematic review of the literature in March 2017. Studies were included if they considered reasons affecting the likelihood of public access defibrillation and presented original data. An electronic search strategy was devised searching MEDLINE and EMBASE, supplemented by bibliography and related-article searches. Given the low-quality and observational nature of the majority of articles, a narrative review was performed. Sixty-four articles were identified in the initial literature search. An additional four unique articles were identified from the electronic search strategies. The following themes were identified related to public access defibrillation: knowledge and awareness; willingness to use; acquisition and maintenance; availability and accessibility; training issues; registration and regulation; medicolegal issues; emergency medical services dispatch-assisted use of automated external defibrillators; automated external defibrillator-locator systems; demographic factors; other behavioural factors. In conclusion, several barriers and facilitators to public access defibrillation deployment were identified. However, the evidence is of very low quality and there is not enough information to inform changes in practice. This is an area in urgent need of further high-quality research if public access defibrillation is to be increased and more lives saved. PROSPERO registration number CRD42016035543.
      PubDate: 2017-07-17
       
  • Trends in mortality and major complications for patients undergoing
           coronary artery bypass grafting among Urban Teaching Hospitals in China:
           2004 to 2013
    • Authors: Yuan X; Zhang H, Zheng Z, et al.
      Abstract: AimsAlthough the number of hospitals performing cardiac surgery has increased rapidly in China, information regarding the trends in coronary artery bypass grafting (CABG) outcomes remains unknown.Methods and resultsWe used data from the Chinese Cardiac Surgery Registry, the largest registry system that accounts for nearly 50% of total annual CABG volume in China, to assess trends of in-hospital mortality and major complication rates for patients receiving isolated CABG in 102 urban teaching hospitals in China from 25 January 2004 through 31 December 2013 (except 2006 and 2009). Using a mixed effects model, we estimated annual trends in each of these two outcomes overall and by age groups (18–64 and 65 years or older), adjusted for patient characteristics. We also assessed the trends in pre-operative, post-operative, and total length of stay (LOS). The study included 40 652 patients across 102 hospitals. Between 2004 and 2013, patients' mean age decreased from 62.7 to 61.4 years, in-hospital mortality decreased from 2.8% to 1.6% (difference, 1.3%, 95% CI: 0.70–1.85), and major complication rates decreased from 7.8% to 3.8% (difference, 4.0%; 95% CI: 3.05–4.90). The reduction in mortality and major complication rates were consistent across age groups. Between 2004 and 2013, the median (inter-quartile range) pre-operative LOS remained unchanged, post-operative LOS declined from 12.0 (8.0) to 10.0 (7.0) days, and total LOS declined from 22.0 (13.0) to 20.0 (12.0) days.ConclusionIsolated CABG-related in-hospital mortality, major complication rates, and LOS have improved in urban teaching hospitals in China over the last decade.
      PubDate: 2017-07-04
       
  • Depression in patients with coronary artery disease: a more significant
           problem than previously recognized'
    • Authors: Carney R; Freedland K.
      Abstract: This editorial refers to ‘The association of depression at any time to the risk of death following coronary artery disease diagnosis’, by H.T. May et al., on page 296.
      PubDate: 2017-06-22
       
  • Systematic review and meta-analysis to compare outcomes between
           intermediate- and high-risk patients undergoing transcatheter aortic valve
           implantation
    • Authors: Singh K; Bhalla A, Qutub M, et al.
      Abstract: AimsRecent studies have reported non-inferior outcomes for transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR) in intermediate-risk patients. However, a comparison of outcomes among TAVI patients depending upon the surgical risk score has not been performed in a large study. Our aim was to compare the outcomes of TAVI in low-, intermediate-, and high-risk patients, to ascertain if the morbidity and mortality is related to the patient’s risk profile or the procedure itself.Methods and resultsA thorough computer-based search was performed using Ovid MEDLINE, EMBASE, Google Scholar, and PubMed databases. We included original research studies reporting data on TAVI in the low-, intermediate-, and high-risk groups. Patients in intermediate-risk group were compared to the high-risk cohort for device success, mortality, and complications. A total of 2414 patients in the intermediate-risk group were compared with 1597 high-risk patients. On meta-analysis, intermediate-risk group demonstrated similar device success [odds ratio (OR) 1.29, 95% confidence interval (CI) 0.87–1.90, I2 = 0%, P = 0.2) but a lower 30-day mortality OR 0.54, 95% CI 0.34–0.86, I2 = 49%, P = 0.009). There was no difference in the incidence of stroke (OR 1.17, 95% CI 0.80–1.71, I2 = 36%, P = 0.42) or permanent pacemaker implantation between the two groups (OR 1.04, 95% CI 0.82–1.32, I2 = 41%, P = 0.74).ConclusionTranscatheter aortic valve implantation in intermediate-risk patients carries a low mortality and high success. Incidence of pacemaker and stroke remains high in the lower risk group.
      PubDate: 2017-06-12
       
  • Prediction of cardiovascular risk in patients with familial
           hypercholesterolaemia
    • Authors: Villa G; Wong B, Kutikova L, et al.
      Abstract: AimsPatients with familial hypercholesterolaemia (FH) have an elevated cardiovascular (CV) risk. The objective of this analysis was to adjust CV risk equations derived in non-FH populations with hyperlipidaemia to predict CV risk in FH patients, and then to use these adjusted CV risk equations in a decision analytic model in order to predict lifetime CV risk in FH patients.Methods and resultsA literature search of publications reporting CV risk in FH patients identified the publication with the most credible estimate of CV risk increase. A CV event rate ratio (RR) (FH vs. non-FH) was derived from reported odds ratios by pooling treated and untreated patients. Predicted CV event risks based on non-FH risk equations were adjusted with the RR to reflect CV risk in FH patients. A decision analytic model incorporating these adjusted risk equations was used to predict 10-year and lifetime CV risk in FH patients. Combining the derived RR of 7.1 (95% CI: 5.7–8.7) with the predicted CV risks in a decision analytic model yielded 10-year and lifetime risk estimates of 45% and 88% in FH patients based on the RUTHERFORD-2 trial population. Based on the initial (cross-sectional) RR of 7.1, FH patients were predicted to have 3.9 times more events over their lifetime than non-FH patients with a similar risk profile.ConclusionThe CV risk in FH is high and represents an unmet medical need for patients. Increased efforts for better diagnosis and management of FH should be employed to improve patient outcomes.
      PubDate: 2017-05-30
       
  • Modelling total coronary heart disease burden and long-term benefit of
           cholesterol lowering in middle aged men with and without a history of
           cardiovascular disease
    • Authors: Packard C; Young R, Ross K, et al.
      Abstract: AimsCumulative coronary heart disease (CHD) events over 20 years were examined in men screened for, and in those randomized to, the West of Scotland Coronary Prevention Study.Methods and resultsRecord linkage provided CHD-related events and days in hospital for the 80 230 screenees, including the randomized cohort of 6595 men. Risk factors were determined at baseline, and disease burden assessed for groups defined by cholesterol. Effects of cholesterol lowering were modelled from differences between groups, and from the treatment arms of the trial. Over 20 years, those without a history of CHD (n = 61 211) had 23.0 events per 100 subjects in the lowest cholesterol group (mean 4.0 mmol/L) and 65.1 per 100 in the highest (8.8 mmol/L). Corresponding days in hospital were 167.2–435.4 per 100 subjects. Analogous figures for men with a CHD history (n = 8570) were 77.3–141.7 events per 100 and 526.1–936.7 hospital days per 100. Lowering cholesterol by about 1.0 mmol/L in men with average cholesterol and no CHD was predicted to be associated with 8.9 fewer events and a saving of 56.0 hospital days per 100. In those with CHD this difference gave, depending on starting level, 26.8–36.5 fewer events and savings of 158.2–247.3 hospital days per 100 subjects. Comparison of cumulative events in 45–54 vs. 55–64 year olds in the trial revealed greater benefit from intervention in the younger decade.ConclusionLong-term, longitudinal data reveal the considerable CHD burden in middle-aged men and indicate substantial clinical benefits from both moderate and aggressive cholesterol lowering.
      PubDate: 2017-05-30
       
  • Duration of dual antiplatelet therapy and associated outcomes following
           percutaneous coronary intervention for acute myocardial infarction:
           contemporary practice insights from the Canadian Observational
           Antiplatelet Study
    • Authors: Russo JJ; Goodman SG, Bagai A, et al.
      Abstract: AimsThere is a paucity of real-world, contemporary data of practice patterns and clinical outcomes following dual-antiplatelet therapy (DAPT) in acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI).Methods and resultsThe Canadian Observational Antiplatelet Study was a prospective, multicentre, cohort study examining adenosine diphosphate receptor antagonist use following PCI for AMI. We compared practice patterns, patient characteristics, and clinical outcomes in relation to DAPT duration (<6 weeks, 6 weeks to <6 months, 6 to <12, and ≥12 months). The primary outcome was the composite of non-fatal AMI, unplanned coronary revascularization, stent thrombosis, new or worsening heart failure, cardiogenic shock, or stroke. We identified 2034 patients with AMI treated with PCI. DAPT duration was <6 weeks in 5.2% of patients; 6 weeks to <6 months in 7.0%; 6 to <12 months in 12.6%; and ≥12 months in 75.3%. Patients who discontinued DAPT early had higher GRACE risk scores. Overall, mortality rate at 15 months was 2.5%. Compared with a duration of DAPT of ≥12 months, discontinuation of DAPT <6 weeks (P < 0.0001) and 6 weeks to <6 months (P = 0.02), but not 6 months to <12 months (P = 0.06), were independently associated with a higher incidence of the primary outcome among survivors.ConclusionOne-in-four patients with AMI treated with PCI discontinued DAPT prior to the guideline-recommended 12-month duration. Patients in whom DAPT was discontinued early were at higher baseline risk and had higher rates of non-fatal ischaemic events during follow up.
      PubDate: 2016-10-15
       
 
 
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