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Quotidiano di informazione – Anno 31 n° 259

Posts Tagged ‘heart attack’

Exercise after a heart attack. It could save your life

Posted by fidest press agency su sabato, 21 aprile 2018

Ljubljana, Slovenia Becoming more physically active after a heart attack reduces the risk of death, according to research presented today at EuroPrevent 2018, a European Society of Cardiology congress.1 The study, which followed more than 22,000 patients, found that those who became more physically active after a heart attack halved the risk of death within four years.
“It is well known that physically active people are less likely to have a heart attack and more likely to live longer,” said lead author Dr Örjan Ekblom, associate professor, Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden. “However, we did not know the impact of exercise on people after a heart attack.” This study, which was a collaboration between the GIH and Centre for Health and Performance at Gothenburg University, Sweden, assessed the association between physical activity and survival after a heart attack. The study included 22,227 patients in Sweden who had a myocardial infarction between 2005 and 2013. Data was obtained from the RIKS-HIA registry, SEPHIA registry, and Swedish Census registry.Levels of physical activity were reported 6–10 weeks and 12 months after the heart attack. The difference between answers was considered a change in physical activity over the year following the heart attack.
On both occasions, patients were asked how many times they had exercised for 30 minutes or longer during the previous seven days. Patients were categorised as constantly inactive, reduced activity, increased activity, or constantly active.A total of 1,087 patients died during an average follow-up of 4.2 years. The researchers analysed the association between the four categories of physical activity and death, after adjusting for age, sex, smoking, and clinical factors. Compared to patients who were constantly inactive, the risk of death was 37%, 51%, and 59% lower in patients in the categories of reduced activity, increased activity, or constantly active, respectively.Dr Ekblom said: “Our study shows that patients can reduce their risk of death by becoming physically active after a heart attack. Patients who reported being physically active 6 to 10 weeks after the heart attack but became inactive afterwards seem to have a carry-over benefit. But of course the benefits for active people are even greater if they remain physically active.”Dr Ekblom said the study provided additional evidence for healthcare professionals and policy makers to systematically promote physical activity in heart attack patients. He said: “Exercising twice or more a week should be automatically advocated for heart attack patients in the same way that they receive advice to stop smoking, improve diet, and reduce stress.”“Our study shows that this advice applies to all heart attack patients,” he continued. “Exercise reduced the risk of death in patients with large and small myocardial infarctions, and for smokers and non-smokers, for example.” Dr Ekblom said the study did not investigate what type of exercise patients undertook. “More research is needed to find out if there is any type of activity that is especially beneficial after a heart attack,” he noted, “Should patients do resistance exercise, aerobic training, or a combination, for example? Is walking sufficient or do patients need more vigorous exercise which makes them short of breath? Answering these questions will help us to give more specific advice.”

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Divorce and low socioeconomic status carry higher risk of second heart attack or stroke

Posted by fidest press agency su venerdì, 20 aprile 2018

Sophia Antipolis. Heart attack survivors who are divorced or have low socioeconomic status have a higher risk of a second attack, according to research from Karolinska Institutet, Stockholm, Sweden, published today in the European Journal of Preventive Cardiology, a European Society of Cardiology journal. Previous studies have shown that low socioeconomic status is associated with a first heart attack, but these findings could not be extended to heart attack survivors to calculate their risk of a second event.This study enrolled 29,226 one-year survivors of a first heart attack from the SWEDEHEART-registry and cross-referenced data from other national registries. Socioeconomic status was assessed by disposable household income (categorised by quintiles) and education level (nine years or less, 10–12 years, more than 12 years). Marital status (married, unmarried, divorced, widowed) was also recorded in the study.Patients were followed up for an average of four years for the first recurrent event, which was defined as non-fatal heart attack, death from coronary heart disease, fatal stroke, or non-fatal stroke.The study found that divorce and low socioeconomic status were significantly associated with a higher risk of a recurrent event. Each indicator was linked with recurrent events.
After adjusting for age, sex, and year of first heart attack, patients with more than 12 years of education had a 14% lower risk of a recurrent event than those with nine or fewer years of education. Patients in the highest household income quintile had a 35% lower risk than those in the lowest quintile.
Unmarried and widowed patients had higher rates of recurrent events than married patients, but the associations were not significant. Study author Dr Joel Ohm, a PhD student at Karolinska Institutet, said the proportions of unmarried and widowed patients in the study may have been too small for the link to be statistically significant. However, he said: “Marriage appears to be protective against recurrent events and aligns with traditional indicators of higher socioeconomic status, but conclusions on the underlying mechanisms cannot be drawn from this study.” In a subgroup analysis by sex, unmarried men were at higher risk of recurrence and unmarried women were at lower risk. “These findings should be interpreted cautiously,” Dr Ohm warned, “This was a subgroup analysis and we cannot conclude that women are better off being single and that men should marry and not divorce. Unmarried women had a higher level of education compared to unmarried men, and this difference in socioeconomic status may be the underlying cause.”
The subgroup analysis by sex also found that higher household income was associated with a lower risk of recurrent events in men, but there was no association in women. Dr Ohm said this could be due to the lower proportion of women in the study (27%), since the age cutoff for inclusion was 76 years and women are generally older than men when they have a first heart attack. In addition, the difference between the lowest and highest quintiles of household income is likely to be greater when men have a first heart attack because they and their spouse are still of working age.The study did not investigate reasons for the association between socioeconomic status and recurrent events. Numerous factors that are difficult to measure may be involved, such as diet and exercise habits throughout life and even genetic factors. In theory, unequal access to healthcare and compliance with treatment regimes could play a role. Of these two, compliance appears to be a bigger issue, since most treatments were prescribed equally to all income groups and adjusting for treatment did not change the association between socioeconomic status and recurrent events.“The take-home message from this study is that socioeconomic status is associated with recurrent events,” said Dr Ohm, “No matter the reasons why, doctors should include marital and socioeconomic status when assessing a heart attack survivor’s risk of a recurrent event. More intense treatment could then be targeted to high risk groups.”

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Heart attack patients prescribed antidepressants have worse one-year survival

Posted by fidest press agency su lunedì, 5 marzo 2018

The observational study of nearly 9,000 patients found that those prescribed antidepressants at discharge from hospital after a heart attack had a 66% greater risk of mortality one year later than patients not prescribed the drugs, although they noted the cause is not necessarily related directly to the antidepressants.Lead author Ms Nadia Fehr, a medical student at the University of Zurich, Switzerland, said: “Previous studies have suggested that cardiovascular disease may increase the likelihood of being depressed. On the other hand, depression appears to increase the probability of developing cardiovascular risk factors. However, little is known about the impact of depression on outcome after a heart attack.”This study assessed the association of antidepressant prescription at hospital discharge with the one-year outcomes of patients with acute myocardial infarction (heart attack).Data from AMIS Plus, the Swiss nationwide registry for acute myocardial infarction, were used to analyse 8,911 heart attack patients admitted to hospitals in Switzerland between March 2005 and August 2016. Patients were followed up by telephone 12 months after discharge.The researchers compared patients who received antidepressant medication at discharge with those who did not with regard to baseline characteristics and one-year outcomes including mortality, a subsequent heart attack, and stroke.A total of 565 (6.3%) patients received antidepressants at discharge from hospital. Compared to those who did not receive the drugs, patients prescribed antidepressants were predominantly female, older, and more likely to have hypertension, diabetes, dyslipidaemia, obesity and comorbidities. They were less likely to undergo percutaneous coronary intervention or receive P2Y12 blockers or statins, and stayed in hospital longer.After adjusting for baseline characteristics the researchers found that the rates of stroke and subsequent heart attacks were similar between the two groups, but patients prescribed antidepressants had significantly worse survival. The rate of all-cause mortality at one-year after discharge was 7.4% in patients prescribed antidepressants compared to 3.4% for those not prescribed antidepressants (p<0.001).Antidepressant prescription was an independent predictor for mortality, and increased the odds by 66% (odds ratio: 1.66; 95% confidence interval: 1.16 to 2.39).“This was an observational study so we cannot conclude that antidepressants caused the higher death rate,” noted Ms Fehr.She concluded: “Our study showed that many patients are treated with antidepressants after a heart attack. More research is needed to pinpoint the causes and underlying pathological mechanisms for the higher mortality we observed in this patient group.”

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Treatment of heart attack patients depends on history of cancer

Posted by fidest press agency su mercoledì, 20 settembre 2017

cuoreSophia Antipolis Treatment of heart attack patients depends on their history of cancer, according to research published today in European Heart Journal: Acute Cardiovascular Care. The study in more than 35 000 heart attack patients found they were less likely to receive recommended drugs and interventions, and more likely to die in hospital if they had cancer than if they did not. “It is well known that cancer patients may have an increased risk of cardiovascular disease as a result of their treatment,” said senior author Dr Dragana Radovanovic, head of the AMIS Plus Data Centre in Zurich, Switzerland. “However, on the other hand, little is known about the treatment and outcomes of cancer patients who have an acute myocardial infarction.”This study investigated whether acute myocardial infarction patients with a history of cancer received the same guideline recommended treatment and had the same in-hospital outcomes as those without cancer.The study included 35 249 patients enrolled in the acute myocardial infarction in Switzerland (AMIS Plus) registry between 2002 and mid-2015. Of those, 1 981 (5.6%) had a history of cancer.Propensity score matching was used to create two groups of 1 981 patients each – one with cancer history and one without – that were matched for age, gender, and cardiovascular risk factors.The researchers compared the proportions of patients in each group who received specific immediate drug therapies for acute myocardial infarction, and percutaneous coronary intervention (PCI) to open blocked arteries. They also compared the rates of in-hospital complications and death between the two groups. The researchers found that cancer patients underwent PCI less frequently (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.67–0.88) and received P2Y12 blockers (OR, 0.82; 95% CI 0.71–0.94) and statins (OR, 0.87; 95% CI, 0.76–0.99) less frequently. In-hospital mortality was significantly higher in patients with cancer than those without (10.7% versus 7.6%; OR, 1.45; 95% CI, 1.17–1.81).Patients with a history of cancer were more likely to have complications while in hospital. They had 44% higher odds of cardiogenic shock, 47% higher chance of bleeding, and 67% greater odds of developing heart failure than those with no history of cancer.Dr Radovanovic said: “Patients with a history of cancer were less likely to receive evidence-based treatments for myocardial infarction. They were 24% less likely to undergo PCI, 18% less likely to receive P2Y12 antagonists and 13% less likely to receive statins. They had also more complications and were 45% more likely to die while in hospital.”“More research is needed to find out why cancer patients receive suboptimal treatment for myocardial infarction and have poorer outcomes,” continued Dr Radovanovic.
“Possible reasons could be the type and stage of cancer, or severe comorbidities. Some cancer patients may have a very limited life expectancy and refuse treatment for myocardial infarction,” she added.

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Smoking rises in Argentina heart attack patients as cigarettes “among cheapest in world”

Posted by fidest press agency su sabato, 15 ottobre 2016

Buenos Aires, Argentina 13 Oct 2016: Levels of smoking are rising in heart attack patients in Argentina, according to a study presented today at the Argentine Congress of Cardiology (SAC 2016). The finbuenos airesdings coincide with a 100% increase in affordability in the last decade, which have made cigarettes among the cheapest in the world.1 Researchers also report improved treatment for heart attacks but no decrease in mortality. The annual congress of the Argentine Society of Cardiology is being held in Buenos Aires from 13 to 15 October. Experts from the European Society of Cardiology (ESC) will present a special programme. The study compared risk factors, treatment and outcomes of heart attack patients using the SCAR (2011) and ARGEN-IAM-ST (2015) surveys conducted by the Argentine Society of Cardiology. The analysis included 676 patients with ST-segment elevation acute myocardial infarction (STEMI), of which 222 were from SCAR and 454 participated in ARGEN-IAM-ST. Only patients from centres participating in both registries were included.There were no significant changes between the two surveys in age, gender, diabetes, high cholesterol or hypertension. Patients who had a heart attack were 60 years old on average, around one-quarter were women, 20% had type 2 diabetes, around half had high cholesterol, and more than half had hypertension.Smoking increased from 42% of heart attack patients in 2011 to 69% in 2015. “Sales of cigarettes in Argentina increased by almost 17% between 2011 and 2015,” said Dr Claudio Higa, leader of the SCAR survey and a cardiologist at Hospital Alemán in Buenos Aires.
“The rise of cigarette prices during the last decade was lower than the increase in incomes, making Argentina one of the countries with the cheapest cigarettes in the world,” he continued. “Our study was observational so we cannot say this caused the increase in smoking but it likely contributed.”Treatment for STEMI improved between the two time periods. The rate of primary angioplasty, the recommended treatment, increased from 89% to 95%. The use of fibrinolytic agents, which are a second option when primary angioplasty is not possible, decreased from 11% to 4%. Regarding the use of antithrombotic and antiplatelet drugs, the use of bivalirudin increased and there were decreases in the use of clopidogrel and glycoprotein IIb/IIIa inhibitors between the two time periods.Looking at outcomes, the prevalence of cardiogenic shock was halved in 2015 compared to 2011, as was postinfarct angina. But there were no differences in the rates of mortality and reinfarction during hospitalisation. Around 6–9% of patients died in hospital after their heart attack and 2% had another event. Dr Higa said: “Treatment for heart attacks has improved in Argentina but unfortunately this has not translated into a reduction in deaths or repeat heart attacks. It could be that more time is needed for better therapy to show an impact, or that the study was too small to show any difference.”He concluded: “Our results confirm that reperfusion therapy is improving in Argentina, as well as the use of evidence based medications. It is also encouraging that the mortality rate is still below 10%, which compares favourably to European surveys. Studies are ongoing to monitor the quality of treatment for heart attacks in Argentina, patient risk factors, and clinical outcomes.”Dr Raúl Alfredo Borracci, a past director of the SAC Research Area and current co-director of the Argentine Journal of Cardiology and professor of biostatistics at Austral University of Argentina, said: “Only if we consider that urgent angioplasty is a better approach than primary fibrinolysis, then, comparative data of SCAR (2011) and ARGEN-IAM-ST (2015) show that reperfusion therapy is improving in Argentina. Nevertheless, antithrombotic and antiplatelet drugs use appears to have been neglected in this same period of time. For instance, the increased use of new drugs such as bivalirudin did not compensate for the reduction of clopidogrel and glycoprotein IIb/IIIa inhibitors.” “Although the authors found no statistical difference between the two mortality rates, it should be emphasised that the sample size is underpowered,” added Dr Borracci. “In fact, the mortality risk of infarction appears to have increased by 33% in the ARGEN-IAM-ST (2015) compared to 2011 (relative risk 1.33, 95% confidence interval 0.73–2.40).”“Some concerns arise regarding smoking rates, since the National Surveys on Risk Factors in Argentina showed a steady decline through 2005 (29.7%), 2009 (27.1%) and 2013 (25.1%) for the general population,” he continued. “Consequently, it is difficult to explain the variation of smoking rates found in the patient cohorts.”Dr Borracci said: “It is well known that smoking rates may vary significantly in times of economic or social crisis; but I do not think that was the situation of Argentina between these periods. A more plausible explanation would be a lack of proper medical advice on the need to quit smoking after a heart attack. This aspect should be emphasised in the care of patients by Argentinean cardiologists.”
Professor Michel Komajda, a past president of the ESC and course director of the ESC programme in Argentina, said: “Smoking is one of the main risk factors for first and repeat heart attacks.3 The chance of dying from cardiovascular disease over a ten year period is approximately doubled in smokers. Kicking the habit is the best thing you can do to reduce your risk, together with being physically active and eating healthy food.”

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First European standards for management of heart attack patients

Posted by fidest press agency su mercoledì, 31 agosto 2016

cardiology congress-2016Rome, Italy The first European standards for the management of heart attack patients are launched today by the European Society of Cardiology-Acute Cardiac Care Association (ESC-ACCA). The quality indicators for acute myocardial infarction (AMI) are published in European Heart Journal: Acute Cardiovascular Care, ACCA’s official journal, and presented at ESC Congress together with the results of the inaugural implementation.1,2“Evaluating quality of care is part of modern healthcare but measuring it is difficult and does not solely rely on patient outcomes,” said first author Professor François Schiele. “For this reason it has become common practice to use quality indicators (QIs).”The first QIs in Europe for assessing the quality of care provided to patients admitted for AMI were developed by the ACCA, a registered branch of the ESC.The 20 QIs are in seven domains which cover the entire patient pathway: centre organisation, reperfusion-invasive strategy, in-hospital risk assessment, antithrombotic treatment during hospitalisation, discharge treatments, patient satisfaction, and composite QIs (CQIs) and mortality. There are 12 main and eight secondary QIs.Professor Schiele said: “The QIs are in line with current ESC guidelines3,4 and were designed with the goal of improving the quality of care for AMI patients across Europe. A second aim is to use them to evaluate how well centres are currently performing and which domains could be improved.”The QIs were implemented for the first time in two French nationwide registries of AMI patients admitted to a coronary or intensive care unit within 48 congress cardiologyhours of symptom onset. The analysis included 7839 patients, of whom 3670 participated in FAST-MI 2005 and 4169 participated in FAST-MI 2010.5For each patient, data was identified that would enable the calculation of the 20 QIs. The researchers also investigated the association between the QIs and three-year mortality. Overall, 12 QIs could be calculated from existing data in FAST-MI 2005 and 14 in FAST-MI 2010. Professor Schiele said: “None of the QIs we calculated showed performance above 90%, which means there is room for improvement in all domains.”The opportunity-based CQI was calculated by dividing the number of times particular care processes were performed by the number of opportunities to provide them. The average score was 52% in 2005 and 72% in 2010. Professor Schiele said: “This suggests that only half of the appropriate care processes were provided to patients admitted with a heart attack in 2005, which rose to 72% in 2010.”Performance on the opportunity-based CQI was divided into quartiles: 0%, 0–40%, 40–80%, and above 80%. The investigators found a decrease in mortality with increasing quartiles of the CQI. Compared to those with a score of 0%, patients with a score between 0 and 40%, 40% to 80%, or above 80% had a 17%, 27%, and 32% lower risk of death, respectively.6Centres with more than 20 patients in the study were benchmarked by comparing their opportunity-based CQI score to the national average in 2005 or 2010. Centres were classified as “low” (below national average), “intermediate” (not significantly different) or “high” quality (above). Twelve centres achieved “high” in 2005 and 22 in 2010, while 16 were classified “low” in 2005 and 17 in 2010.Professor Schiele said: “The opportunity-based CQI was related to survival, which provides further justification for assessing quality of care. The CQI also made it possible to classify centres as having high, average or low quality of care.”

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Low socioeconomic status associated with higher risk of second heart attack or stroke

Posted by fidest press agency su sabato, 27 agosto 2016

cardiology congress-2016Rome, Italy Fiera di Roma (Ingresso Nord, Via Portuense 1645/1647) Low socioeconomic status is associated with a higher risk of a second heart attack or stroke, according to research presented at ESC Congress 2016 today.1 The study in nearly 30 000 patients with a prior heart attack found that the risk of a second event was 36% lower for those in the highest income quintile compared to the lowest and increased by 14% in divorced compared to married patients.Lead author Dr Joel Ohm, a physician at the Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden, said: “Are you rich or poor? Married or divorced? That might affect your risk of a second heart attack or stroke. Advances in prevention and acute treatment have increased survival after heart attack and stroke over the past several decades. The result is that more people live with cardiovascular disease – in Sweden almost one fifth of the total population is in this group.”
Most research on cardiovascular prevention is based on healthy people and it is unclear if the findings apply to patients with established disease. An association between socioeconomic status in healthy individuals and future cardiovascular disease was found in the 1950s. This study investigated the link between socioeconomic status in patients who had survived a first heart attack and the risk of a second heart attack or a stroke.The study included 29 953 patients from the Swedish nationwide registry, Secondary Prevention after Heart Intensive Care Admission (SEPHIA), who had been discharged approximately one year previously from a cardiac intensive care unit after treatment for a first myocardial infarction. Data on outcome over time and socioeconomic status (defined as disposable income, marital status and level of education) was obtained from Statistics Sweden and the National Board of Health and Welfare.During an average follow up of four years, 2405 patients (8%) suffered a heart attack or stroke. After adjusting for age, gender, smoking status, and the defined measures of socioeconomic status, being divorced was independently associated with a 14% greater risk of a second event than being married. There was an independent and linear relationship between disposable income and the risk of a second event, with those in the highest quintile of income having a 36% lower risk than those in the lowest quintile (figures 1 and 2). A higher level of education was associated with a lower risk of events but the association was not significant after adjustment for income. (photo: cardiology congress)

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