Influence of Comorbid Conditions on One-Year Outcomes in Non–ST-Segment Elevation Acute Coronary Syndrome

Sanchís, Juan; Núñez, Julio; Bodı́, Vicente; Núñez, Eduardo; García‐Álvarez, Ana; Bonanad, Clara; Regueiro, Ander; Bosch, Xavier; Heras, Magda; Sala, Joan; Bielsa, Oscar; Llàcer, Àngel

doi:10.4065/mcp.2010.0702

Cited by 60 publications

(52 citation statements)

References 28 publications

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“…While the mechanisms contributing to nonadherence are complex, cognitive dysfunction and low levels of health literacy have been associated with adverse outcomes in those with ACS and heart failure, respectively. An investigation of the prognostic influence of comorbid conditions in a cohort of patients with non-ST elevation ACS found the presence of dementia predicted death (hazard ratio 3.1) 19. In a study of ambulatory heart failure patients with New York Heart Association class II–IV symptoms, 37% had low literacy.…”

Section: Discussionmentioning

confidence: 99%

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Marzec¹,

Carey²,

Lambert-Kerzner³

et al. 2015

PPA

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BackgroundPatient nonadherence to cardiac medications following acute coronary syndrome (ACS) is associated with increased risk of recurrent events. However, the prevalence of cognitive dysfunction and poor health literacy among ACS patients and their association with medication nonadherence are poorly understood.MethodsWe assessed rates of cognitive dysfunction and poor health literacy among participants of a clinical trial that tested the effectiveness of an intervention to improve medication adherence in patients hospitalized with ACS. Of 254 patients, 249 completed the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) survey, an assessment of risk for poor literacy, and the St Louis University Mental Status (SLUMS) exam, a tool assessing for neurocognitive deficits, during ACS hospitalization. We assessed if SLUMS or REALM-R scores were associated with medication adherence.ResultsBased on SLUMS score, 14% of patients were categorized as having dementia, and 52% with mild neurocognitive disorder (MNCD). Based on REALM-R score of ≤6, 34% of patients were categorized as at risk for poor health literacy. There was no association between poor health literacy and medication nonadherence. Of those with MNCD, 35.5% were nonadherent, compared to 17.5% with normal cognitive function and 6.7% with dementia. In multivariable analysis, cognitive dysfunction was associated with medication nonadherence (P=0.007), mainly due to an association between MNCD and nonadherence (odds ratio =12.2, 95% confidence interval =1.9 to 243; P=0.007). Cognitive status was not associated with adherence in patients randomized to the intervention.ConclusionCognitive dysfunction and risk for poor health literacy are common in patients hospitalized with ACS. We found an association between MNCD and medication nonadherence in the usual care group but not in the intervention group. These findings suggest efforts to screen for MNCD are needed during ACS hospitalization to identify patients at risk for nonadherence and who may benefit from an adherence intervention.

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Section: Discussionmentioning

confidence: 99%

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Marzec¹,

Carey²,

Lambert-Kerzner³

et al. 2015

PPA

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“…To be included in the final analytic cohort, a patient also had to be enrolled in the data set over a 6‐month baseline assessment period. Baseline chronic conditions were defined using ICD‐9‐CM algorithms for Charlson comorbidities and bleeding . In addition, to better address detailed diagnoses of a cerebrovascular morbidity, baseline cerebrovascular events were classified into transient ischemic attack, ischemic stroke, and cerebrovascular bleeding including intracerebral and subarachnoid hemorrhage .…”

Section: Methodsmentioning

confidence: 99%

“…Baseline chronic conditions were defined using ICD-9-CM algorithms for Charlson comorbidities and bleeding. 21,22,[29][30][31][32] In addition, to better address detailed diagnoses of a cerebrovascular morbidity, baseline cerebrovascular events were classified into transient ischemic attack, ischemic stroke, and cerebrovascular bleeding including intracerebral and subarachnoid hemorrhage. [33][34][35] The types of ACS diagnoses (STEMI or NSTE-ACS) were also determined based on the diagnosis codes used in a peer-reviewed study.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

Comparative Effectiveness of Oral Antiplatelet Agents in Patients with Acute Coronary Syndrome

Kim

Lee

Ardati³

et al. 2017

Pharmacotherapy

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OBJECTIVE In randomized controlled trials, prasugrel and ticagrelor reduced cardiovascular complications in patients with acute coronary syndrome (ACS) compared with clopidogrel. However, limited head-to-head comparisons have been conducted across the three antiplatelet agents using real-world data. The aim of this study was to compare clinical outcomes of three strategies during a 1-year period after percutaneous coronary intervention (PCI). METHODS Rates of all-cause and acute myocardial infarction (AMI) hospitalizations were compared retrospectively using an insurance claims database. Patients who filled a prescription for an oral antiplatelet agent between September 2011 and December 2013 for post ACS-PCI care were identified. Time to allcause and AMI hospitalization for a 365-day postdischarge period was compared using Cox proportional hazard models controlling for potential confounders within a propensity score matched cohort. RESULTS A matched cohort of 9504 clopidogrel, 7128 prasugrel, and 2376 ticagrelor patients was analyzed. The 1-year hazard ratio (HR) for the two newer agents versus clopidogrel was 0.84 (0.78-0.91). The HR for the newer agents versus clopidogrel of admission with AMI as the primary diagnosis was 0.78 (0.61-1.03), and for AMI as any diagnosis during a hospitalization was 0.88 (0.77-1.00). The HR of all-cause admission for ticagrelor versus prasugrel was 0.97 (0.84-1.13), and the HRs of AMI-related admission were not statistically significant between the two agents. Robustness checks across statistical methods to control for potential confounders did not influence the conclusion. CONCLUSION This real-world study demonstrated that use of the newer agents following PCI was associated with a decrease in all-cause and AMI-related hospitalizations. However, no significant difference was found in the rate of admission between ticagrelor versus prasugrel. Due to concerns regarding statistical power, future studies should examine larger cohorts to obtain more precise estimates for AMI hospitalization for ticagrelor and prasugrel.

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“…Перенесений інфаркт міокарда (ІМ) в анамнезі встановлено у 49 (15 %) пацієнтів, з них у 5 раніше виконували черезшкірну ангіопластику зі стентуванням, у 2 -аортокоронарне шунтування (АКШ). Інші супутні захворювання, які враховували в дослідженні, є компонентами простого індексу коморбідності (ІК), нещодавно розробленого для популяції хворих із ГКС без підйому сегмента ST [16]. Тяжку дисфункцію нирок (рівень клубочкової фільтрації < 20 мл/(хв • 1,73 м 2 )) діагностовано у 7 (2 %) пацієнтів, деменцію -в 1 (0,3 %) пацієнта, серцеву недостатність в анамнезі (задокументована фракція викиду лівого шлуночка (ФВЛШ) < 40 %) -у 66 (20 %): при наявності цих супутніх станів для розрахунку ІК нараховували по 2 бали.…”

Section: матеріали і методиunclassified

Effect of myocardial revascularization upon long-term prognosis of patients with acute coronary syndrome and concomitant dıseases

Komorovsky¹

2019

CSIC

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Тернопільський національний медичний університет імені І.Я. Горбачевського Вплив реваскуляризації міокарда на віддалений прогноз у пацієнтів із гострим коронарним синдромом та супутніми захворюваннями Мета роботи-оцінити вплив реваскуляризації міокарда на віддалений прогноз у хворих із гострим коронарним синдромом (ГКС) і супутніми захворюваннями. Матеріали і методи. Проведено аналіз виживання 337 послідовних пацієнтів із ГКС з урахуванням простого індексу коморбідності (ІК) і стратегії лікування. Як кінцеві точки дослідження розглядали серцеву смерть або нефатальний інфаркт міокарда (ІМ). Результати. Наявність коморбідних станів встановлено у 150 (45 %) пацієнтів. За значеннями простого ІК розподіл пацієнтів був таким: 0-187 (55 %), 1-71 (21 %), ≥ 2-79 (23 %). Упродовж періоду спостереження (медіана-19 міс) настання кінцевої точки (серцевої смерті або нефатального ІМ) зареєстровано у 29 (9 %) пацієнтів. Спостерігався статистично значущий лінійний тренд до збільшення частоти подій при зростанні ІК (χ2 = 14,59; р = 0,0001). Прогностичний ефект реваскуляризації міокарда щодо досягнення кінцевих точок суттєво не відрізнявся від ефекту консервативного лікування і при ІК = 0 відношення ризиків (ВР) становило 0,75; 95 % довірчий інтервал (ДІ) 0,16-3,33 (р = 0,68), при ІК = 1 ВР становило 1,71; 95 % ДІ 0,325-10,20 (р = 0,61), при ІК ≥ 2 ВР становило 0,65; 95 % ДІ 0,23-1,84 (р = 0,42). Предикторами серцевих подій були фракція викиду лівого шлуночка, ураження периферійних артерій та ІК ≥ 2. Висновки. Інвазивна стратегія лікування порівняно із консервативним підходом у пацієнтів із ГКС і коморбідністю та мультиморбідністю не дозволила в цьому дослідженні досягти статистично значущого зниження ризику смерті та нефатального ІМ у віддалений період. Kлючові слова: гострий коронарний синдром, коморбіднiсть, мультиморбідність, прогноз, реваскуляризація. Посилання: Коморовський Р.Р. Вплив реваскуляризації міокарда на віддалений прогноз у пацієнтів із гострим коронарним синдромом та супутніми захворюваннями // Кардіохірургія та інтервенційна кардіологія.-2019.-№ 2.-С. 31-38. To cite this article: Komorovsky RR. Effect of myocardial revascularization upon long-term prognosis of patients with acute coronary syndrome and concomitant dıseases.

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Influence of Comorbid Conditions on One-Year Outcomes in Non–ST-Segment Elevation Acute Coronary Syndrome

Cited by 60 publications

References 28 publications

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Comparative Effectiveness of Oral Antiplatelet Agents in Patients with Acute Coronary Syndrome

Effect of myocardial revascularization upon long-term prognosis of patients with acute coronary syndrome and concomitant dıseases

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