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.
Sigurnost pacijenata i osoblja je standard kvalitete zdravstvene zaštite propisan Pravilnikom o standardima kvalitete i načinu njihove primjene. Prema Zakonu o kvaliteti zdravstvene zaštite, ...sigurnost zdravstvenog postupka podrazumijeva osiguravanje zdravstvenih
postupaka od štetnih neželjenih događaja. Navedeno obvezuje na uspostavu sustava sigurnosti, odnosno na izvještavanje, analizu i prevenciju medicinskih pogrešaka koje često mogu prouzročiti neželjene događaje. Praćenjem i analizom učestalosti tih pokazatelja dobivaju se korisne informacije o trendovima i mogućnostima sprječavanja budućih neželjenih događaja. Jedan od pokazatelja bolesnikove sigurnosti u bolničkom sustavu zdravstvene zaštite je stopa standardizirane smrtnosti, a prati se za određene dijagnozeUVOD Stopa smrtnosti od akutnog miokardnog infarkta je jedna od tih dijagnoza. Ova stopa smrtnosti ne ovisi samo o kliničkom procesu, već na nju utječu i drugi faktori. Prema izvješću Organizacije
za ekonomsku suradnju i razvoj (Organisation for Economic Cooperation and Development – OECD), stopa smrtnosti za oboljele od akutnog miokardnog infarkta unutar 30 dana od prijma u bolnicu iznosi 10,8 %. U Kliničkom bolničkom centru Sestre milosrdnice u 2015. iznosila je 9 %, što je pokazatelj dobrog upravljanja sigurnošću bolesnika.
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