Prevalence of Comorbidities and Their Impact on Hospital Management and Short-Term Outcomes in Vietnamese Patients Hospitalized with a First Acute Myocardial Infarction

Abstract

BackgroundCardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with a first acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi for purposes of describing the prevalence of cardiovascular (CVD) and non-CVD comorbidities and their impact on hospital management, in-hospital clinical complications, and short-term mortality in these patients.MethodsThe study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010.ResultsThe average age of study patients was 66 years and one third were women. The proportions of patients with none, any 1, and ≥ 2 CVD comorbidities were 34%, 42%, and 24%, respectively. Among the CVD comorbidities, hypertension was the most commonly reported (59%). There were decreasing trends in the proportion of patients who were treated with effective cardiac medications and coronary interventions as the number of CVD comorbidities increased. Patients with multiple CVD comorbidities tended to develop acute clinical complications and die at higher rates during hospitalization compared with patients with no CVD comorbidities (Odds Ratio: 1.40; 95% Confidence Interval: 0.40–4.84).ConclusionsOur data suggest that patients with multiple cardiac comorbidities tended to experience high in-hospital death rates in the setting of AMI. Full-scale surveillance of Hanoi residents hospitalized with AMI at all Hanoi hospitals is needed to confirm these findings. Effective strategies to manage Vietnamese patients hospitalized with AMI who have multiple comorbidities are warranted to improve their short-term prognosis.

Prognostic impact of multimorbidity in patients with type 2 diabetes and ST-elevation myocardial infarction

“…This, in part, supports earlier findings [ 14 , 18 ]. However, in contrast to our findings others report depression [ 18 ] and GI bleeding/ulcer [ 19 ] to be diagnosed in a significant proportion of the studied population. Radovanovic et al studied over 30 000 patients who were enrolled into the AMIS Plus registry and found that 7%, 6%, and 2% of patients were reported to have kidney disease, lung disease, and GI ulcer respectively [ 15 ].…”

“…Moreover, patients with three or more noncardiac comorbidities had markedly increased odds of dying during hospitalization compared to those with no noncardiac comorbidities previously diagnosed [ 14 ]. In contrast to the previously mentioned analyses, but similarly to our study, Nguyen et al found similar in-hospital mortality rates irrespective of the number of comorbid conditions 6.8%, 5.5%, and 9.7% for 0, 1, and 2 or more comorbidities respectively P=0.53) [ 19 ]. Possible explanations for the lack of impact of multimorbidity on in-hospital mortality in our cohort include: i) the effect of T2DM on in-hospital mortality, (ii) similar age, (iii) similar rate of cardiogenic shock and multivessel coronary artery disease, (iv) similar time from symptom onset, and (v) similar rate of successful PCI among others.…”

“…Comorbidities were grouped into two categories: (a) CVD comorbidities which included hypertension (HTN), atrial fibrillation (AF), heart failure (HF), hyperlipidemia, stroke, and peripheral artery disease (PAD); and (b) non-CVD criteria which included chronic obstructive pulmonary disease (COPD), asthma, cancer, anemia, peptic ulcer/GI bleeding, chronic kidney disease (CKD) stage ≥ 3 (estimated glomerular filtration rate below 60 mL/min/1.73 m 2 ), thyroid disorders (hypo-/hyperthyroidism, goiter), depression, and connective tissue disease (CTD). The afore-mentioned CVD and non-CVD were selected based on the findings of previous reports that have pointed to the association of these conditions with outcomes following AMI [ 12 – 14 , 19 ].…”

Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam

“…Treatment cost of the first and following years after the first acute MI event was calculated based on expert opinion. We applied a proportion of 68.5% patients with a first acute MI who had percutaneous coronary intervention or coronary artery bypass surgery [ 31 ] in the first-year treatment. We also assumed that there was no specific treatment or rehabilitation for stroke patients after acute events, which is common in Vietnam, where rehabilitation and long-term care is done by family members.…”

Factores asociados a la estancia hospitalaria prolongada en adultos mayores

“…Cares y cols hallaron en su estudio que los pacientes con un puntaje más alto en el índice de Charlson no presentaron estadías hospitalarias más prolongadas (1), al igual que nosotros que no encontramos asociación entre la variable comorbilidades y la estancia hospitalaria prolongada en adultos mayores. Sin embargo, Nguyen y Teo en sus estudios e n c o n t r a r o n q u e l o s p a c i e n t e s c o n comorbilidades tendían a experimentar a una estancia hospitalaria prolongada (12,13). Otro estudio de mostró que las comorbilidades están asociadas con una población de pacientes ancianos con estadía hospitalaria prolongada (14).…”