Acute myocardial infarction (AMI) affects patients' health-related quality of life (HRQOL). AMI may decrease HRQOL, thus negatively affecting QOL. However, the improvements in interventional ...treatment and early rehabilitation after AMI may have a positive effect on HRQOL.
We evaluated HRQOL in patients after the first AMI treated in a reference cardiology centre in Poland and assessed which clinical variables affect HRQOL after AMI.
We prospectively evaluated HRQOL in 60 consecutive patients suffering after their first AMI during the index hospitalisation and again after 6 months, using: (i) MacNew, (ii) World Health Organization Quality of Life (WHOQOL) BREF, and (iii) Short Form (SF) 36.
As measured by the MacNew questionnaire, global, social, and physical functioning did not change (p≥0.063), whereas emotional functioning improved 6 months after AMI, compared to index hospitalisation (p=0.002). As measured by WHOQOL BREF, physical health, psychological health, and environmental functioning did not change (p≥0.321), whereas social relationships improved 6 months after AMI (p=0.042). As assessed by SF-36, the global HRQOL improved after AMI (p=0.044). Patients with improved HRQOL in SF-36 often had a higher baseline body mass index (p=0.046), dyslipidaemia (p=0.046), and lower left ventricle ejection fraction (LVEF; p=0.013). LVEF<50% was the only variable associated with improved HRQOL in multivariate analysis (OR 4.463, 95% CI 1.045 - 19.059, p=0.043).
HRQOL increased 6 months after the first AMI, especially in terms of emotional functioning and social relationships. Patients with LVEF<50% were likely to have improved HRQOL.
The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events ...and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI.
A total of 324 patients admitted in the Coronary Care Unit of 'Mother Teresa' hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient's medical file. Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment.
Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31-4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:1.05-3.71), and multivessel disease (OR=6.32; 95% CI: 1.43-28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24-0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures.
A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs.
The patients and staff safety is one of the healthcare quality standards listed by "The Rules on quality standards and the method of their application". The healthcare care law implies medical ...procedure safety with the main goal avoiding harmful adverse events. That fact obliges establishing system security by reporting, analyzing and preventing medical errors that can often cause unwanted incidents. By monitoring and analyzing the frequency of certain indicators we can obtain useful information on trends and possible ways to prevent such future events. One of the indicators of patient safety in hospital healthcare system is standardized mortality rate which is used in monitoring specific diagnosis. One of them being acute myocardial heart attack. Mortality rate of acute myocardial heart attack depends not only on the clinical process but also on some other factors that can also be present and affect it. According to the Organisation for Economic Co-operation and Development report, mortality rate for the patients with acute myocardial heart attack within 30 days of hospital admission is 10,8%, while in the Sestre milosrdnice University Hospital Center mortality rate in the year of 2015 was only 9 % which is a good outcome indicator for patient safety management in this hospital.
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