Association of multiple preventive therapies postdischarge and long-term health outcomes after acute myocardial infarction
Chih‐Wei ChenYi‐Cheng LinChun-Ming ShihWan‐Ting ChenFeng‐Yen LinWei‐Fung BiYung‐Ta KaoKuang‐Hsing ChiangChao‐Shun ChanChien‐Yi HsuTsung‐Lin YangCheng‐Yi HsiaoBu‐Yuan HsiaoLi‐Nien ChienChun‐Yao Huang
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Statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guidelines as secondary prevention medications to improve the long-term outcomes of post-acute myocardial infarction (AMI) patients. However, adequate drug adherence has always been challenging, and different treatment regimens may lead to divergent outcomes that remain unclear under current myocardial infarction (MI) care standards. This study investigated the association between use of different preventive regimens post-AMI and patients' long-term outcomes.This cohort study used data files from the Taiwan National Health Insurance Research Database. A total of 77 520 people who were hospitalized with AMI between 2002 and 2015 were assessed. On the basis of medication possession ratio (MPR) to individual medications, eight treatment groups were examined in this study. Receiving therapy was defined as MPR ≥40%. We investigated the association between different treatment groups and all-cause mortality in 24 months.Overall, 51 322 patients with ST-elevation MI and 26 198 with non-ST-elevation MI were included in the study. Patients received all three preventive medications show the lowest mortality in 24 months follow-up periods among all treatment groups. Patients who did not usage of any of these three preventive medications had the highest mortality in 24 months (adjusted hazard ratio, 1.78; 95% CI, 1.64-1.93). This mortality rate had the same pattern across the three cohort generations (2002-2005, 2006-2010, and 2011-2015).In this large population-based real-world study, usage of three preventive therapies post-MI was associated with the lowest rate of all-cause mortality.Variations in the ratio of "definite" to "possible" myocardial infarction for non-fatal cases were examined in studies that used World Health Organization criteria. There were large variations in this ratio, variations which appeared to be due to differences in the ascertainment of non-fatal cases of "possible" myocardial infarction, which, in turn, contributed to reported differences in the incidence of myocardial infarction. A significant proportion of cases of "possible" myocardial infarction probably do not have ischemic heart disease at all, since, in our data, cases of "possible" myocardial infarction (non-fatal) with a hospital discharge diagnosis of chest pain (undiagnosed) had a risk of death that was no worse than that in the general population. Thus the most reproducible, and possibly most accurate estimates of the incidence of myocardial infarction may come from including only fatal cases of "possible" myocardial infarction with both fatal and non-fatal cases of "definite" myocardial infarction.
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Objective To analyze the clinical characteristics of atypical acute myocardial infarction,improve the diagnosis of myocardial infarction. Methods To analyze the main clinical characteristics of the patients with atypical acute myocardial infarction in our hospital in the past 3 years ,which compared to the typical acute myocardial infarction. Results Atypical acute myocardial infarction includes atypical symptom and atypical ECG, atypical symptoms is more prevail. Compared with typical acute myocardial infarction, the women, elderly people and hypertension patients is more common, fewer anterior myocardial infarction and poorer prognosis ( P ＜ 0.05 ). Conclusion To improve the understanding of atypical acute myocardial infarction,was benefit of reducing the misdiagnosis and mistreatment of acute myocardial infarction.
Key words:
Myocardial infarction
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Background and objectives Sedentary behavior is associated with increased mortality in the general population. Whether replacing sedentary behavior with low- or light-intensity activities confers a survival benefit in the general or CKD populations is unknown. Design, setting, participants, & measurements This observational analysis of the 2003–2004 National Health and Nutrition Examination Survey examined the associations of low- and light-intensity activities with mortality. On the basis of the number of counts/min recorded by an accelerometer, durations of sedentary (<100/min), low (100–499/min), light (500–2019/min), and moderate/vigorous (≥2020/min) activity were defined and normalized to 60 minutes. The mortality associations of 2 min/hr less sedentary duration in conjunction with 2 min/hr more (tradeoff) spent in one of the low, light, or moderate/vigorous activity durations while controlling for the other two activity durations were examined in multivariable Cox regression models in the entire cohort and in the CKD subgroup. Results Of the 3626 participants included, 383 had CKD. The mean sedentary duration was 34.4±7.9 min/hr in the entire cohort and 40.8±6.8 in the CKD subgroup. Tradeoff of sedentary duration with low activity duration was not associated with mortality in the entire cohort or the CKD subgroup. Tradeoff of sedentary duration with light activity duration was associated with a lower hazard of death in the entire cohort (hazard ratio, 0.67; 95% confidence interval, 0.48 to 0.93) and CKD subgroup (hazard ratio, 0.59; 95% confidence interval, 0.35 to 0.98). Tradeoff of sedentary duration with moderate/vigorous activity duration had a nonsignificant lower hazard in the entire cohort and CKD subgroup. Conclusions Patients with CKD are sedentary nearly two thirds of the time. Interventions that replace sedentary duration with an increase in light activity duration might confer a survival benefit.
Subgroup analysis
Sedentary lifestyle
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Background and objectives
Sedentary behavior is associated with increased mortality in the general population. Whether replacing sedentary behavior with low- or light-intensity activities confers a survival benefit in the general or CKD populations is unknown.Design, setting, participants, & measurements
This observational analysis of the 2003–2004 National Health and Nutrition Examination Survey examined the associations of low- and light-intensity activities with mortality. On the basis of the number of counts/min recorded by an accelerometer, durations of sedentary (<100/min), low (100–499/min), light (500–2019/min), and moderate/vigorous (≥2020/min) activity were defined and normalized to 60 minutes. The mortality associations of 2 min/hr less sedentary duration in conjunction with 2 min/hr more (tradeoff) spent in one of the low, light, or moderate/vigorous activity durations while controlling for the other two activity durations were examined in multivariable Cox regression models in the entire cohort and in the CKD subgroup.Results
Of the 3626 participants included, 383 had CKD. The mean sedentary duration was 34.4±7.9 min/hr in the entire cohort and 40.8±6.8 in the CKD subgroup. Tradeoff of sedentary duration with low activity duration was not associated with mortality in the entire cohort or the CKD subgroup. Tradeoff of sedentary duration with light activity duration was associated with a lower hazard of death in the entire cohort (hazard ratio, 0.67; 95% confidence interval, 0.48 to 0.93) and CKD subgroup (hazard ratio, 0.59; 95% confidence interval, 0.35 to 0.98). Tradeoff of sedentary duration with moderate/vigorous activity duration had a nonsignificant lower hazard in the entire cohort and CKD subgroup.Conclusions
Patients with CKD are sedentary nearly two thirds of the time. Interventions that replace sedentary duration with an increase in light activity duration might confer a survival benefit.Subgroup analysis
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Background Although most people with relapsing onset multiple sclerosis (R-MS) eventually transition to secondary progressive multiple sclerosis (SPMS), little is known about disability progression in SPMS. Methods All R-MS patients in the Cardiff MS registry were included. Cox proportional hazards regression was used to examine a) hazard of converting to SPMS and b) hazard of attaining EDSS 6.0 and 8.0 in SPMS. Results 1611 R-MS patients were included. Older age at MS onset (hazard ratio [HR] 1.02, 95%CI 1.01–1.03), male sex (HR 1.71, 95%CI 1.41–2.08), and residual disability after onset (HR 1.38, 95%CI 1.11–1.71) were asso- ciated with increased hazard of SPMS. Male sex (EDSS 6.0 HR 1.41 [1.04–1.90], EDSS 8.0 HR 1.75 [1.14–2.69]) and higher EDSS at SPMS onset (EDSS 6.0 HR 1.31 [1.17–1.46]; EDSS 8.0 HR 1.38 [1.19–1.61]) were associated with increased hazard of reaching disability milestones, while older age at SPMS was associated with a lower hazard of progression (EDSS 6.0 HR 0.94 [0.92–0.96]; EDSS 8.0: HR 0.92 [0.90–0.95]). Conclusions Different factors are associated with hazard of SPMS compared to hazard of disability progres- sion after SPMS onset. These data may be used to plan services, and provide a baseline for comparison for future interventional studies and has relevance for new treatments for SPMS RobertsonNP@cardiff.ac.uk
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Objective To investigate the clinical feature of painless myocardial infarction. Methods To retrospectively study the clinical data of 33 patients who suffered from painless myocardial infarction, and compare with that of typical acute myocardial infarction patients. Results There wash' t significant difference in gender(χ2 =1.63, P >0.05) and past history (χ2 = 4.88, P > 0.05) ,the time from visit to diagnosis (t = 1.44, P > 0.05) between painless myocardial infarction patients and typical acute myocardial infarction patients. But there was significant differ-ence in the age (χ2= 5.72, P < 0.05), the visit time (t = 30.98, P < 0.05), and the prognosis (χ2 = 32.17, P <0.0 ). Conclusion Patients with painless myocardial infarction have diverse clinical manifestations. They are usu-ally aged and delayed in seeking treatment and at last have a bad prognosis.
Key words:
Myocardial Infarction; Clinical feature
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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In 1,395 patients admitted to hospital between 1976 and 1981 due to suspected acute myocardial infarction, the 5-year mortality rate was related to whether they developed infarction or not during the first 3 days. In all, patients with definite myocardial infarction had a 5-year mortality rate of 33.4% as compared with 13.3% in patients not fulfilling the criteria for this diagnosis (p less than 0.001). When separately analyzing patients with no previous myocardial infarction before admission and discharged from hospital, the corresponding mortality rate was 24.1% for myocardial infarction patients versus 8.1% in nonmyocardial infarction patients (p less than 0.001). Among all patients with nonconfirmed myocardial infarction, those who partly fulfilled the criteria (possible myocardial infarction) had a 5-year mortality rate of 16.7% as compared with 12.0% in those in whom myocardial infarction was completely ruled out (p = 0.18). Independent risk factors for death among patients not developing early infarction were high age and a clinical history of previous myocardial infarction and smoking. We conclude that in this study the long-term prognosis among patients admitted to hospital due to suspected acute myocardial infarction was clearly related to whether they developed an infarction or not during the first 3 days in hospital.
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