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[10-year mortality of patients admitted to coronary units with or without confirmed diagnosis of myocardial infarction. A relation to anamnesis and diagnosis at discharge]

https://arctichealth.org/en/permalink/ahliterature48374
Source
Ugeskr Laeger. 1995 Jul 3;157(27):3894-7
Publication Type
Article
Date
Jul-3-1995
Author
J. Launbjerg
P. Fruergaard
J K Madsen
L S Mortensen
J F Hansen
Author Affiliation
Medicinsk afdeling B, Hillerød Sygehus.
Source
Ugeskr Laeger. 1995 Jul 3;157(27):3894-7
Date
Jul-3-1995
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Coronary Care Units - statistics & numerical data
Denmark - epidemiology
English Abstract
Female
Humans
Male
Middle Aged
Myocardial Infarction - diagnosis - drug therapy - mortality
Patient Admission
Patient Discharge
Prognosis
Risk factors
Time Factors
Verapamil - therapeutic use
Abstract
The ten-year mortality in patients with suspected myocardial infarction with (AMI) and without (non-AMI) confirmed diagnosis was evaluated in 1897 non-AMI patients and 1401 AMI patients who were consecutively admitted to hospital during The Danish Verapamil Infarction Study. The following risk factors contained independent prognostic information about mortality for non-AMI patients: age, previous AMI, sex and diabetes. In patients with AMI the risk factors were: age, previous AMI, clinical heart failure, diabetes and angina pectoris. When the diagnosis at discharge for non-AMI patients was included in the Cox-analysis, only the diagnoses of bronchopneumonia, musculoskeletal disorders and observation only of added prognostic information. We conclude that non-AMI patients are at high risk for mortal events in the long-term. High risk patients can be identified from the medical history and should be carefully evaluated regarding coronary artery disease at the time of discharge in order to improve the risk stratification, treatment and prognosis.
PubMed ID
7645063 View in PubMed
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Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores.

https://arctichealth.org/en/permalink/ahliterature168850
Source
J Crit Care. 2006 Jun;21(2):142-50
Publication Type
Article
Date
Jun-2006
Author
Monica Norena
Hubert Wong
Willie D Thompson
Sean P Keenan
Peter M Dodek
Author Affiliation
Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada V6Z 1Y6.
Source
J Crit Care. 2006 Jun;21(2):142-50
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
British Columbia
Comorbidity
Coronary Care Units - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Regression Analysis
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Treatment Outcome
Abstract
Comparison of outcomes among intensive care units (ICUs) requires adjustment for patient variables. Severity of illness scores are associated with hospital mortality, but administrative databases rarely include the elements of these scores. However, these databases include the elements of comorbidity scores. The purpose of this study was to compare the value of these scores as adjustment variables in statistical models of hospital mortality and hospital and ICU length of stay after adjustment for other covariates.
We used multivariable regression to study 1808 patients admitted to a 13-bed medical-surgical ICU in a 400-bed tertiary hospital between December 1998 and August 2003.
For all patients, after adjusting for age, sex, major clinical category, source of admission, and socioeconomic determinants of health, we found that Acute Physiology and Chronic Health Evaluation (APACHE) II and comorbidity scores were significantly associated with hospital mortality and that comorbidity but not APACHE II was significantly associated with hospital length of stay. Separate analysis of hospital survivors and nonsurvivors showed that both APACHE II and comorbidity scores were significantly associated with hospital length of stay and APACHE II score was associated with ICU length of stay.
The value of APACHE II and comorbidity scores as adjustment variables depends on the outcome and population of interest.
PubMed ID
16769457 View in PubMed
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Age as a determinant of cardiopulmonary resuscitation outcome in the coronary care unit.

https://arctichealth.org/en/permalink/ahliterature214983
Source
J Am Geriatr Soc. 1995 Jun;43(6):634-7
Publication Type
Article
Date
Jun-1995
Author
C. Brymer
E. Gangbar
K. O'Rourke
G. Naglie
Author Affiliation
Department of Medicine, University of Western Ontario, London, Canada.
Source
J Am Geriatr Soc. 1995 Jun;43(6):634-7
Date
Jun-1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Aging
Cardiopulmonary Resuscitation - statistics & numerical data
Coronary Care Units - statistics & numerical data
Coronary Disease - epidemiology
Female
Heart Arrest - therapy
Hospital Mortality
Hospitals, Teaching
Humans
Length of Stay
Male
Middle Aged
Ontario - epidemiology
Patient Discharge
Retrospective Studies
Survival Rate
Tachycardia, Ventricular - epidemiology
Treatment Outcome
Ventricular Fibrillation - epidemiology
Abstract
To determine whether age is associated with the outcome of cardiopulmonary resuscitation (CPR) in the coronary care unit (CCU).
Retrospective chart review.
The coronary care units of two Canadian tertiary care teaching hospitals.
Two hundred sixty-four coronary care unit patients undergoing cardiopulmonary resuscitation between January 1, 1985 and June 30, 1992.
There was no significant difference in survival to discharge after CPR between patients less than 70 years of age (17.0%) and patients 70 years of age and older (17.2%) (odds ratio = 0.99; 95% confidence interval = 0.46, 1.80). Patients 70 years of age and older who survived to discharge after CPR had significantly greater lengths of stay (28.1 vs 19.3 days, P = .008).
Age was not associated with a difference in survival to discharge after CPR in the CCU, although a clinically significant difference could not be excluded because of limited power.
PubMed ID
7775721 View in PubMed
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Atrial fibrillation in patients admitted to coronary care units in western Sweden - focus on obesity and lipotoxicity.

https://arctichealth.org/en/permalink/ahliterature273759
Source
J Electrocardiol. 2015 Sep-Oct;48(5):853-60
Publication Type
Article
Author
Sigfus Gizurarson
Marcus Ståhlman
Anders Jeppsson
Yangzhen Shao
Björn Redfors
Lennart Bergfeldt
Jan Borén
Elmir Omerovic
Source
J Electrocardiol. 2015 Sep-Oct;48(5):853-60
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Atrial Fibrillation - epidemiology - metabolism
Causality
Comorbidity
Coronary Care Units - statistics & numerical data
Diabetic Cardiomyopathies - epidemiology - metabolism
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Lipid Metabolism
Lipid Metabolism Disorders - epidemiology - metabolism
Male
Middle Aged
Obesity - epidemiology - metabolism
Registries
Risk assessment
Sex Distribution
Sweden - epidemiology
Abstract
Atrial fibrillation (AF) is the most common form of arrhythmia in humans and is associated with substantial morbidity and mortality. Obesity and diabetes have been linked to myocardial lipotoxicity - a condition where the heart accumulates and produces toxic lipid species. We hypothesized that obesity and diabetes were involved in the pathophysiology of AF by means of promoting a lipotoxic phenotype in atrial muscle, and that AF predicts mortality in cardiac care patients.
Our study consists of two parts. The first part is a registry study based on prospective data obtained through the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) from hospitals in western Sweden. All consecutive patients between 2006 and 2011 admitted to coronary care unit (CCU) with sinus rhythm (SR) or AF were included in the analysis. Multivariate logistic regression and Cox proportional-hazards regression were used to test whether diabetes and obesity were independent predictors of AF at admission to CCU and whether AF was associated with increased one-year mortality. In the second part we obtained atrial biopsies from 54 patients undergoing cardiac surgery and performed lipidomic analysis for a detailed qualitative and quantitative analysis of lipid species including triglycerides (TAG), ceramides (CER), phosphatidylcholine (PC), lysophosphatidylcholine (LPC), phosphatidylethanolamine (PE), sphyngomyelins (SM), free cholesterol (FC), cholesterol esters (CEs) and diacylglycerols (DAGs).
Between 2006 and 2011, 35232 patients were admitted to CCUs in western Sweden, mostly due to ischemic heart disease, heart failure, arrhythmia, syncope and chest pain. The mean age was 66years and 58.7% were male. There was a high prevalence of obesity (20.3%) and diabetes (16.8%). Obesity (OR 1.35, 95% CI 1.17-1.56, P
PubMed ID
25666738 View in PubMed
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Canadian-American differences in the management of acute coronary syndromes in the GUSTO IIb trial: one-year follow-up of patients without ST-segment elevation. Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) II Investigators.

https://arctichealth.org/en/permalink/ahliterature197232
Source
Circulation. 2000 Sep 19;102(12):1375-81
Publication Type
Article
Date
Sep-19-2000
Author
Y. Fu
W C Chang
D. Mark
R M Califf
B. Mackenzie
C B Granger
E J Topol
M. Hlatky
P W Armstrong
Author Affiliation
University of Alberta, Edmonton, Alberta, Canada.
Source
Circulation. 2000 Sep 19;102(12):1375-81
Date
Sep-19-2000
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Angina, Unstable - mortality - therapy
Canada
Coronary Care Units - statistics & numerical data
Female
Fibrinolytic Agents - therapeutic use
Heparin - therapeutic use
Hirudin Therapy
Humans
Male
Myocardial Infarction - mortality - therapy
Myocardial Revascularization - utilization
Physician's Practice Patterns
Regression Analysis
Treatment Outcome
United States
Abstract
Little information exists concerning practice patterns between Canada and the United States in the management of myocardial infarction (MI) patients without ST-segment elevation and unstable angina.
We examined the practice patterns and 1-year outcomes of 2250 US and 922 Canadian patients without ST-elevation acute coronary syndromes in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb trial. The US hospitals more commonly had on-site facilities for angiography and revascularization. These procedures were performed more often and sooner in the United States than Canada, whereas Canadian patients were more likely to undergo noninvasive stress testing. The length of initial hospital stay was 1 day longer for Canadian than US patients. Recurrent and refractory ischemia was more common in Canada. One-year mortality was comparable between the 2 countries. However, at 6 months, even after baseline differences were accounted for, the (re)MI rate was significantly higher in Canadian than US patients with unstable angina (8.8% versus 5.8%, P:=0.039), as was the composite rate of death or (re)MI (13.1% versus 9.1%, P:=0.016).
One-year mortality was comparable between Canada and the United States in both MI and unstable angina cohorts despite higher intervention rates in the United States. However, outcomes at 6 months among patients with unstable angina differed. Whereas more frequent coronary interventions were not associated with reduced recurrent MI or death among MI patients without ST elevation, they may favorably affect outcomes in patients with unstable angina.
PubMed ID
10993855 View in PubMed
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Comparison of mortality in patients with acute myocardial infarction accidentally admitted to non-cardiology departments versus that in patients admitted to coronary care units.

https://arctichealth.org/en/permalink/ahliterature258749
Source
Am J Cardiol. 2014 Oct 15;114(8):1151-7
Publication Type
Article
Date
Oct-15-2014
Author
Maria D'Souza
Lotte Saaby
Tina S Poulsen
Axel C P Diederichsen
Susanne Hosbond
Søren Z Diederichsen
Torben B Larsen
Henrik Schmidt
Oke Gerke
Jesper Hallas
Gunnar Gislason
Kristian Thygesen
Hans Mickley
Source
Am J Cardiol. 2014 Oct 15;114(8):1151-7
Date
Oct-15-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Chest Pain - diagnosis
Coronary Care Units - statistics & numerical data
Denmark - epidemiology
Diagnosis, Differential
Diagnostic Errors
Electrocardiography
Female
Follow-Up Studies
Hospital Mortality - trends
Hospitals, University - statistics & numerical data
Humans
Inpatients
Male
Myocardial Infarction - diagnosis - mortality - therapy
Patient Admission - statistics & numerical data
Prospective Studies
Survival Rate - trends
Time Factors
Troponin I - blood
Abstract
The aim of this study was to prospectively investigate the clinical characteristics including symptoms and long-term mortality in patients with acute myocardial infarction (AMI) accidentally admitted to non-cardiology departments (NCDs). For comparison, similar observations in patients admitted to the coronary care unit (CCU) were collected. During a 1-year period, consecutive patients having cardiac troponin I measured at the Odense University Hospital were considered. The hospital has 27 clinical departments. Patients were classified as having an AMI if the diagnostic criteria of the universal definition were met. Follow-up was at least 1 year with mortality as the clinical end point. Of 3,762 consecutive patients, an AMI was diagnosed in 479, of whom 114 patients (24%) were hospitalized in NCDs and 365 (76%) in the CCU. Chest pain or chest discomfort more frequently occurred in patients from the CCU (83%) than in patients from the NCDs (45%, p
PubMed ID
25169985 View in PubMed
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Declining hospital mortality in acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature11632
Source
Eur Heart J. 1994 Jan;15(1):5-9
Publication Type
Article
Date
Jan-1994
Author
M. Dellborg
P. Eriksson
M. Riha
K. Swedberg
Author Affiliation
Department of Medicine, University of Göteborg, Ostra Hospital, Sweden.
Source
Eur Heart J. 1994 Jan;15(1):5-9
Date
Jan-1994
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aspirin - therapeutic use
Coronary Care Units - statistics & numerical data
Female
Hospital Mortality - trends
Hospitals, University
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality
Nitroglycerin - therapeutic use
Sweden - epidemiology
Thrombolytic Therapy
Abstract
Beta-blockers, nitrates, aspirin and thrombolytic drugs have each separately been shown to reduce mortality in acute myocardial infarction, but the effect of these treatments combined during routine coronary care has not been assessed. The coronary care unit at Ostra Hospital services a stable community of 250,000 inhabitants. Since 1984 all patients have been entered into a computerized database. In addition, information on age, sex, discharge diagnosis and hospital outcome is also available for patients admitted between 1979 and 1983. In 1984, routine treatment with intravenous beta-blockers was introduced, to be followed in 1986 by intravenous nitroglycerin and in 1988 by aspirin in all patients without contraindications. Since 1988, intravenous thrombolytic treatment has been also given routinely to all patients with ST-elevation and chest pain
PubMed ID
7909751 View in PubMed
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Demographics, treatment and outcome of acute coronary syndromes: 17 years of experience in a specialized cardiac centre.

https://arctichealth.org/en/permalink/ahliterature170649
Source
Can J Cardiol. 2006 Feb;22(2):121-4
Publication Type
Article
Date
Feb-2006
Author
Jean-Pierre S Awaida
Jocelyn Dupuis
Pierre Théroux
Guy Pelletier
Michel Joyal
Pierre De Guise
Serge Doucet
Luc Bilodeau
Bernard Thibault
Jean-Francois Tanguay
Richard Gallo
Jean Grégoire
Philippe L L'Allier
Laurent Macle
Anil Nigam
Author Affiliation
Research Centre, Montreal Heart Institute, and Department of Medicine, University of Montreal, Quebec, Canada.
Source
Can J Cardiol. 2006 Feb;22(2):121-4
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Age Distribution
Angioplasty, Balloon, Coronary - statistics & numerical data
Cerebral Revascularization - statistics & numerical data
Coronary Care Units - statistics & numerical data
Coronary Disease - epidemiology - therapy
Demography
Female
Humans
Intra-Aortic Balloon Pumping - statistics & numerical data
Male
Middle Aged
Outcome Assessment (Health Care)
Prospective Studies
Quebec - epidemiology
Retrospective Studies
Sex Distribution
Stents - statistics & numerical data
Treatment Outcome
Abstract
Epidemiological information on patients with acute coronary syndromes managed in specialized cardiac centres is limited.
To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period.
A prospective database of 18,719 patients admitted from April 1986 to March 2003 in a 21-bed CCU was analyzed.
From 1986 to 2003, the number of admissions increased from 937 to 1577 per year, while the length of stay declined from 7.5 to 3.5 days. The mean age increased from 58.4 to 63.4 years, and the proportion of men remained stable at approximately 70%. The use of coronary angiograms increased from 49.8% to 81.1% in all patients, while fibrinolysis dropped to 0.4%. In-hospital mortality decreased from 9% to 1.5%. The percentage of overall instrumentation (arterial line, central venous catheter, temporary pacemaker, Swan-Ganz catheter and intra-aortic balloon pump) decreased from 38% to 8.1%. From 1995 to 2003, the proportion of stenting during percutaneous transluminal coronary angioplasty increased dramatically from 0% to 86%. In the past five years, surgical revascularization has remained stable at approximately 20% of all admissions. The proportion of patients discharged with a noncoronary chest pain diagnosis has remained constant at approximately 4%.
There has been a tremendous increase in efficiency, with an approximate doubling of the admissions turnover rate in a tertiary CCU. Patients with acute coronary syndromes are stratified faster and treated more invasively. Therapeutic advances are reflected by an almost linear 0.5% per year decrease in in-hospital mortality.
Notes
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PubMed ID
16485046 View in PubMed
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Discontinuation of smokeless tobacco and mortality risk after myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature256721
Source
Circulation. 2014 Jul 22;130(4):325-32
Publication Type
Article
Date
Jul-22-2014
Author
Gabriel Arefalk
Kristina Hambraeus
Lars Lind
Karl Michaëlsson
Bertil Lindahl
Johan Sundström
Author Affiliation
From the Department of Medical Sciences (G.A., L.L., B.L., J.S.) and Department of Surgical Sciences (K.M.), Uppsala University, Uppsala, Sweden; and the Department of Cardiology, Falu Hospital, Falu, Sweden (K.H.). gabriel.arefalk@medsci.uu.se.
Source
Circulation. 2014 Jul 22;130(4):325-32
Date
Jul-22-2014
Language
English
Publication Type
Article
Keywords
Aged
Coronary Care Units - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Models, Theoretical
Myocardial Infarction - mortality - rehabilitation
Proportional Hazards Models
Prospective Studies
Registries
Risk
Smoking - epidemiology
Smoking Cessation - statistics & numerical data
Sweden - epidemiology
Tobacco Use Cessation - statistics & numerical data
Tobacco, Smokeless - adverse effects
Abstract
Given the indications of increased risk for fatal myocardial infarction (MI) in people who use snus, a moist smokeless tobacco product, we hypothesized that discontinuation of snus use after an MI would reduce mortality risk.
All patients who were admitted to coronary care units for an MI in Sweden between 2005 and 2009 and were
PubMed ID
24958793 View in PubMed
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Errors in the intensive care unit (ICU). Experiences with an anonymous registration.

https://arctichealth.org/en/permalink/ahliterature201467
Source
Acta Anaesthesiol Scand. 1999 Jul;43(6):614-7
Publication Type
Article
Date
Jul-1999
Author
H. Flaatten
O. Hevrøy
Author Affiliation
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Source
Acta Anaesthesiol Scand. 1999 Jul;43(6):614-7
Date
Jul-1999
Language
English
Publication Type
Article
Keywords
Coronary Care Units - statistics & numerical data
Hospitals, University
Humans
Intensive Care Units - statistics & numerical data
Medical Errors - statistics & numerical data
Medication Errors - statistics & numerical data
Norway
Recovery Room - statistics & numerical data
Abstract
In order to obtain information about the occurrence and severity of errors in an ICU, this investigation was conducted in a combined ICU and postoperative ward at a Norwegian University Hospital.
An anonymous registration was conducted in order to reveal as many as possible of all errors in the unit. A separate registration form was used, recording the type of error, date and time, sex and age of the patient, patient condition (unstable/stable) and where the error occurred (on the ward or during transport). The registration started in October 1995, and reports until November 1996 are included (13 months). Consequences of the errors were graded using a 6-point scale (0=no consequences and 5=fatal). Two experienced intensivists and two experienced ICU nurses independently evaluated the errors using a visual analogue scale (VAS) with 10 as the worst imaginable error. All four were blinded to consequences of the error.
A total of 87 errors was reported: 36 (41.3%) were medication errors, 17 (19.5%) related to intravenous infusions, 15 (17.2%) were due to technical equipment failure, and the rest (19 errors, 21.8%) miscellaneous. No consequences could be detected in 55 cases (63%) (grade 0). Six errors were graded as 1, and 22 (25%) as grade 2 (therapeutic intervention necessary, no damage recorded). Five errors had more serious consequences, and one was fatal. The scoring of errors varied a great deal. Mean VAS score was 4.2 (SD 1.7). The sum of VAS score (max. 40) on each error followed a normal distribution, and 12 errors had a score >25.
Errors happen frequently in the ICU. Probably, our data do not represent the true incidence of errors in the period, which we believe was higher. Many errors are graded as serious or severe, but still have limited consequences for the patient.
PubMed ID
10408814 View in PubMed
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22 records – page 1 of 3.