Background Previous studies have shown that adult hypertension is associated with additional cardiovascular risk factors. Students with high BP had significantly higher BMI (24.1 v. 19.0, p<0.001), ...resting (84 v. 81, p<0.001) and recovery heart rate (112 v. 105, p<0.001), triglyceride (112 v. 85, p<0.001) and total cholesterol levels (159 v. 155, p=0.021), and significantly lower HDL cholesterol levels (47 v. 52, p<0.001).
There was significant variation in OAC use by physician specialty: OAC rates of 58% among cardiologists, 53% among hospitalists and internal medicine providers, and 52% among family practice ...providers and other providers P<0.001. Conclusion Among patients hospitalized with AF and risk factors for stroke, OAC at discharge was more common for cardiologists, although fewer than 6 in 10 cardiology patients received OAC.
Preexisting or new-onset atrial fibrillation (AF) commonly occurs in patients with an acute coronary syndrome (ACS). However, it is currently unknown if previous or new-onset AF confers different ...risks in these patients. To determine the prognostic significance of new-onset and previous AF in patients with ACS, we evaluated all patients with ACS enrolled in the multinational Global Registry of Acute Coronary Events (GRACE) between April 1999 and September 2001. We compared clinical characteristics, management, and hospital outcomes in patients with ACS and new-onset and previous AF with those without AF. Of a total of 21,785 patients with ACS enrolled in GRACE, 1,700 (7.9%) had previous AF and 1,221 (6.2%) had new-onset AF. Patients with any AF were older, more likely to be women, had more co-morbid conditions, and worse hemodynamic status. Most in-hospital adverse events (reinfarction, shock, pulmonary edema, bleeding, stroke, and mortality) were significantly higher in patients with any AF than those without AF. Only new-onset AF (not previous AF) was an independent predictor of all adverse in-hospital outcomes. We conclude that compared with patients with ACS without any AF, previous and new-onset AF are associated with increased hospital morbidity and mortality. However, only new-onset AF is an independent predictor of in-hospital adverse events in patients with ACS.
ABSTRACT
Objective: To analyze the construct validity of the EQ‐5D in patients with acute coronary syndromes (ACS).
Methods: All ACS-diagnosed patients discharged from a university-affiliated ...hospital during a 3‐year period were mailed a questionnaire that included the EQ‐5D and the SF‐8. The EQ‐5D includes a visual analogue scale (EQ VAS) to measure self-reported current health-status (0–100) and a five-item descriptive system measuring mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Also included were disease severity measures Duke Activity Status Index (DASI), cardiac symptom count (SC), patient-perceived cardiac disease severity, comorbidity measures (Charlson comorbidity index, total medication count), and other demographic and disease-related items.
Results: Of 1217 patients, 490 (40.3%) responded. Patients averaged 65.2 (SD 11.3) years of age; 71.0% male; 91.9% Caucasian; 64.3% history of MI. Only 0.2%–0.4% of EQ‐5D items and 8% of the EQ VAS were left unanswered by respondents. The nine most common health states were identified based on the five EQ‐5D item scores. Levels of responses to EQ‐5D items and the EQ VAS score were significantly better for patients with very mild/mild perceived disease severity compared to severe/very severe, for patients with lower comorbidity, for patients with lower symptom responses, and for patients with a higher cardiac-related functioning. EQ VAS score and SF‐8 subscale score correlation coefficients ranged from 0.527 to 0.798 (all p < 0.0001). Significant differences were observed between the response level of individual EQ‐5D items and scores of comparable SF‐8 subscales.
Conclusions: This study demonstrated the construct validity of the EQ‐5D in a population-based sample of patients with a history of ACS.
National guidelines recommend the use of secondary prevention modalities for patients with peripheral artery disease (PAD) and coronary artery disease. The effect of prior PAD on the treatment and ...outcomes of patients with acute coronary syndromes (ACS), however, is not well characterized. The objectives of this study were to assess treatment practices and hospital outcomes in patients with ACS and prior PAD.
Data were analyzed from 41,108 patients aged ≥18 years with ACS and enrolled in the large multinational GRACE between 1999 and 2004.
Of the 41,108 patients, 4003 (9.7%) had prior PAD. Patients with PAD were older, more likely to be men, to have a variety of prior comorbidities, and to present with non–ST-segment elevation myocardial infarction and a higher Killip class than patients without PAD. Patients with PAD were less likely to be treated with effective cardiac medications than patients without PAD. At the time of hospital presentation, patients with prior PAD had low rates of use of beneficial cardiac medications, including angiotensin-converting enzyme inhibitors, aspirin, β-blockers, and lipid-lowering agents. Patients with PAD were significantly more likely to experience the composite hospital end point (death, shock, recurrent angina, stroke) than patients without prior PAD (adjusted OR 1.17; 95% CI 1.08−1.26).
Patients with prior PAD received less aggressive treatment with proven cardiac medications during hospitalization for an ACS than patients without PAD. Utilization of beneficial medical therapies in patients with PAD before hospitalization with ACS was also less than optimal. Given the poorer hospital outcomes in patients with PAD, our findings suggest considerable opportunity to improve care for these high-risk patients.
BACKGROUND
Nonadherence to medication may lead to poor medical outcomes.
OBJECTIVE
To describe medication-taking behavior of patients with a history of acute coronary syndromes (ACS) for 4 classes of ...drugs and determine the relationship between self-reported adherence and patient characteristics.
METHODS
Consenting patients with the diagnosis of ACS were interviewed by telephone approximately 10 months after discharge. The survey elicited data characterizing the patient, current medication regimens, beliefs about drug therapy, reasons for discontinuing medications, and adherence. The survey included the Beliefs About Medicine Questionnaire providing 4 scales: Specific Necessity, Specific Concerns, General Harm, and General Overuse, and the Medication Adherence Scale (MAS). Multivariate regression was used to determine the independent variables with the strongest association to the MAS. A p value ≤0.05 was considered significant for all analyses.
RESULTS
Two hundred eight patients were interviewed. Mean ± SD age was 64.9 ± 13.0 years, with 60.6% male, 95.7% white, 57.3% with a college education, 87.9% living with ≥1 other person, and 42% indicating excellent or very good health. The percentage of patients continuing on medication at the time of the survey category ranged from 87.4% (aspirin) to 66.0% (angiotensin-converting enzyme inhibitors). Reasons for stopping medication included physician discontinuation or adverse effects. Of patients still on drug therapy, the mean MAS was 1.3 ± 0.4, with 53.8% indicating nonadherence (score >1). The final regression model showed R2 = 0.132 and included heart-related health status and Specific Necessity as significant predictor variables.
CONCLUSIONS
After ACS, not all patients continue their drugs or take them exactly as prescribed. Determining beliefs about illness and medication may be helpful in developing interventions aimed at improving adherence.
Aims To evaluate clinical outcomes associated with the combined use of clopidogrel and statins vs. clopidogrel alone on a background of aspirin therapy in patients with the spectrum of acute coronary ...syndromes (ACS). Methods and results Utilizing data from the Global Registry of Acute Coronary Events, we studied 15 693 patients admitted with non-ST-segment elevation myocardial infarction (MI) or unstable angina, dividing them according to discharge medications: aspirin alone (group I); aspirin + clopidogrel (group II); aspirin + statin (group III); aspirin + clopidogrel + statin (group IV). Among the groups of patients in whom clopidogrel was used (groups II and IV), group II patients were older, more likely to have prior MI, but less likely to have a history of prior revascularization. In-hospital cardiac catheterization and revascularization rates were similar between groups II and IV. Importantly, Kaplan–Meier analysis showed that the 6 month mortality rate was lower in group IV (log-rank test 22.8, P<0.0001). The hazard ratio for the 6 month mortality rate was adjusted using the Cox proportional hazard model for confounding variables and for propensity score, and the 6 month mortality rate for patients in group IV remained lower compared with those in group II 0.59 (0.41–0.86), P<0.0001. Conclusion Our data suggest that the combination of clopidogrel with a statin has synergistic effects on the clinical outcomes of patients with non-ST-segment elevation ACS.
Patients’ beliefs about their disease may affect their willingness to engage in preventive health behaviors. We sought to determine whether men and women with acute coronary syndrome differ in their ...perceptions of the severity of cardiac-related illness while controlling for the clinical severity of their condition.
All patients with acute coronary syndrome discharged from a university hospital during a 3-year period were mailed a questionnaire, and medical records were abstracted. The questionnaire assessed perceived severity of cardiac-related illness (5-point scale from “very mild” to “very severe”), symptom frequency, type of acute coronary syndrome event, number of medications, Duke Activity Status Index (DASI), time since most recent cardiac event, Charlson Comorbidity Index, and demographic information. A logistic regression model was constructed with perceived severity of heart disease as the dependent variable. Gender was the key independent variable while controlling for the other patient and disease variables.
The 490 respondents (1217 surveys sent, 40.3% response rate) included 348 men and 142 women who were similar with regard to race and type of acute coronary syndrome event experienced. Women were older, less educated, had a lower DASI score, had more symptoms, and were taking more medications. However, they perceived their cardiac disease as being no more severe than the men. The significant predictors in the regression model of perceived severity included gender, DASI, number of symptoms, type of acute coronary syndrome event, and comorbidity. Female gender was associated with lower perceived severity (odds ratio 0.30-0.80).
Women rate their cardiac disease as less severe than do men when controlling for other measures of cardiac disease severity.
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