BACKGROUND: Cardiac rehabilitation (CR) is well documented, in randomised trials, to reduce mortality risk after myocardial infarction (MI). Selection of healthy patients for CR is a relatively unexplored problem. Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality, re-admission and invasive treatment among CR-attendees as compared to CR-non-attendees. Methods: From a cohort of 138 290 persons aged 30-69 years, we identified consecutive MI patients, between 1 April 2000 and 31 March 2002. There were 206 MI patients, who survived until admission, and among the 200 who survived 30 days, 145 (72.5%) attended a comprehensive CR programme. Data were obtained from patient charts and from Danish population registers, and as a result we had no non-participation for the study. RESULTS: The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8% among CR-attendees and CR-non-attendees, respectively (P
Thermal stress, food poisoning, infectious diseases, malnutrition, psychiatric illness as well as injury and death from floods, storms and fire are all likely to become more common as the earth warms and the climate becomes more variable. In contrast, obesity, type II diabetes and coronary artery disease do not result from climate change, but they do share causes with climate change. Burning fossil fuels, for example, is the major source of greenhouse gases, but it also makes pervasive physical inactivity possible. Similarly, modern agriculture's enormous production of livestock contributes substantially to greenhouse gas emissions, and it is the source of many of our most energy-rich foods. Physicians and societies of medical professionals have a particular responsibility, therefore, to contribute to the public discourse about climate change and what to do about it.
ReprintIn: Ugeskr Laeger. 2008 Aug 25;170(35):2667-818761852
Production of livestock accounts for 18% of anthropogenic greenhouse gas emissions. Although livestock products can alleviate malnutrition in poor countries, they are associated with diseases of affluence in wealthy countries. Red meat (pork, beef, sheep and goat), especially, is associated with higher rates of death due to cardiovascular disease and cancer. A policy of reducing consumption of red meat in wealthy countries and encouraging a limited consumption increase in poor countries would benefit the climate as well as human health.
We investigated whether intensive cholesterol lowering could more effectively prevent heart failure (HF) in secondary prevention. The IDEAL study was a 4.8-year prospective, randomized trial comparing "usual" simvastatin treatment (20 to 40 mg/day, n = 4,449) with high-dose atorvastatin (80 mg/day, n = 4,439) in patients with a history of myocardial infarction (MI). At baseline, 94% of patients (n = 8,351) had no history of HF. During the course of the trial, there were 222 new or recurrent hospitalizations for HF (57 and 165 in those with and without HF at baseline, respectively), 123 (2.8%) in the simvastatin group and 99 (2.2%) in the atorvastatin group (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.62 to 1.05, p = 0.11). After adjustments, atorvastatin 80 mg was associated with a 26% decrease of new HF events compared with simvastatin 20 to 40 mg (HR 0.74, 95% CI 0.57 to 0.97, p = 0.03). Atorvastatin tended to be associated with fewer HF events in those with HF at baseline (n = 537, HR 0.65, 95% CI 0.38 to 1.11, p = 0.11) and those without HF at baseline (n = 8,351, HR 0.80, 95% CI 0.59 to 1.09, p = 0.15). Also, HF without preceding MI (n = 187) was decreased (HR 0.73, 95% CI 0.54 to 0.97, p = 0.03). In conclusion, atorvastatin 80 mg was more efficient than simvastatin 20 to 40 mg in preventing development of HF in patients with previous MI.
OBJECTIVE: Prognosis among patients admitted with possible acute coronary syndrome (ACS) may differ from that of patients with definite ACS. The aim of this study was to identify risk factors for mortality among unselected patients and to use the statistical model to identify patients at low or high mortality risk. METHODS: From April 1, 2000, to March 31, 2002, we identified all consecutive patients aged 30 to 69 years admitted to the 2 coronary care units covering the municipality of Aarhus, Denmark (population, 138,290). ACS was considered a possible diagnosis if the physician at admission (1) had noted the presence or absence of chest pain, (2) performed a 12-lead electrocardiogram, and (3) measured markers of myocardial necrosis. In 1576 consecutive patients these criteria were fulfilled. RESULTS: By logistic regression, predictors of mortality were age 60 and older, ST elevation, right bundle-branch block, arrhythmia, elevated markers of myocardial necrosis, and the diagnosis of ACS. The predictive validity of the model, as indicated by receiver operating characteristic curve area, was 85.7%, 87.8%, and 80.1% for 7-, 30-, and 365-day mortality, respectively. CONCLUSIONS: Mortality may be predicted with high precision based on a statistical model. Identification of survivors by the use of a statistical model was superior as compared to simply ruling out the clinical diagnosis of ACS.
BACKGROUND: Most prognostic studies of the acute coronary syndrome (ACS) have been performed in patients selected for inclusion into clinical trials. We stratified the risk of death during the year after hospitalization for a first episode of ACS in unselected patients based on clinical and socio-economic information. METHODS: In 2000-2002 we identified 457 consecutive unselected patients admitted to hospital with a first episode of ACS. Vital status was obtained from Danish national registers. RESULTS: The 1-year case-fatality proportion was 9.8%. Positive predictors of mortality were living alone, Q waves and diabetes. Negative predictors were chest pain, ST elevation and treatment with angioplasty or thrombolysis.