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Hypertension is an important risk factor for the morbidity and mortality of cardiovascular and cerebrovascular diseases. Improving compliance is the key to the prevention and control of hypertension in community. This paper summarizes the improvement of compliance of patients with hypertension， analyzes the ideas and feasibility of assisting hypertension community prevention and control from three aspects： improving medication compliance， improving behavior compliance and digital intelligent management， and puts forward corresponding suggestions to improve the compliance of patients with hypertension.
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Objective:To investigate the current situation of insomnia in patients with acute coronary syndrome (ACS), and analyze the influencing factors of insomnia in the ACS patients, so as to provide information on the development of new strategies for the treatment of insomnia in ACS patients.Methods:This is a multicenter and prospective observational study. A total of 771 ACS patients who met the criteria were selected from March 2013 to June 2015. The baseline social demographic information, sleep quality questionnaire, general anxiety disorder scale-7(GAD-7),patient health questionnaire-9(PHQ-9), short-form 12 health survey questionnaire(SF-12), and enhancing recovery in coronary heart disease patients social inventory(ESSI) were completed within 7 days after admission. Logistic regression analyses were used to analyze the influencing factors of insomnia in ACS patients.Results:A total of 741 subjects with valid questionnaires were collected, including 510 males (68.8%) and 231 females (31.2%). Among them, 487 (65.7%) subjects had at least one insomnia symptom: 308 (41.6%) subjects had difficulty in falling asleep, 369 (49.8%) subjects were easy to wake at night, 116 (15.7%) subjects woke up earlier than they expected, 74 (10.0%) subjects experienced both woke up earlier and difficulty in falling asleep, and 53 (7.2%) subjects woke up earlier, woke up at night and had difficulty in falling asleep at the same time. Logistic regression analyses showed that before admission physical activity ( OR =0.636, 95% CI 0.411-0.984), depression ( OR=1.908, 95% CI 1.101-3.305) and low social support ( OR=0.278, 95% CI 1.198-3.301) were independent factors of insomnia in ACS patients. Conclusions:Nearly 2/3 ACS patients have symptoms of insomnia. Difficulty in falling asleep and easy to wake up at night are the most common manifestations. Physical activity, depression and social support independently are associated with insomnia.
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Objective:To investigate the impact of diabetes mellitus (DM) and stroke on long-term outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods:Total 411 consecutive ACS patients undergoing PCI at the Ninth People′s Hospital of Zhengzhou between December 2014 and June 2018 were recruited, including 319 males and 92 females with a mean age of (64.7±10.1) years. These patients were divided into 4 groups according to the presence or absence of history of diabetes or stroke: non-DM non-stroke group ( n=192) , DM group ( n=140), stroke group ( n=41), and DM+stroke group ( n=38). The data of baseline demographic characteristics, clinical feature, coronary angiographic findings, and cardiovascular adverse events during long-term follow-up were obtained. Kaplan-Meier curves were used to investigate the long-term clinical outcomes among groups. Results:The mean interval of follow-up was (24.1±13.8) months. Patients with DM+stroke had the highest rates of non-fetal myocardial infarction (χ 2=24.932) , non-fetal stroke (χ 2=9.434) , hospitalization due to heart failure/angina (χ 2=69.290) , revascularization (χ 2=22.918) , cardiovascular death(χ 2=13.473)and all-cause death(χ 2=17.724)as well as hard endpoint events (the sum of non-fetal myocardial infarction, non-fetal stroke, and all-cause death) (χ 2=30.268)and combined major adverse cardiovascular events (MACE) (the sum of hard endpoint events, hospitalization due to heart failure/angina, and revascularization) (χ 2=119.556)among 4 groups(all P<0.01). In Kaplan-Meier survival analysis, the cumulative ratio of freedom from all-cause death decreased significantly in DM+stroke group compared with no DM no stroke group ( HR=17.121, 95 %CI: 2.527-115.934, P<0.01), but no statistical difference was observed in the cumulative ratio of freedom from all-cause death between DM+stroke group and DM group or stroke group respectively ( HR=3.178, 95 %CI: 0.744-13.582; HR=1.383, 95 %CI: 0.374-5.118; all P>0.05) . Meanwhile, patients with DM+stroke presented significantly lower cumulated ratio free from combined MACE than patients with non-DM non-stroke ( HR=5.423, 95 %CI:2.941-10.036, P<0.01), and the cumulated ratio free from combined MACE also decreased significantly in DM+stroke group as compared to DM group or stroke group respectively ( HR=1.859,95 %CI: 1.167-2.962; HR=1.991,95 %CI: 1.178-3.364; all P<0.01) . Conclusions:ACS patients with combined history of DM and stroke have a worse long-term outcomes after PCI than those with DM alone or stroke alone or without DM or stroke. DM and stroke seemed to have an additive effect on decrease in the cumulative ratio free from combined MACE in ACS patients following PCI.
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Objective To investigate the potential effects of vegetables and fruits (F&V) consumption on the prevention of hypertension in Chinese population of North China.Methods A cohort of 10 635 cases were established in Kailuan community in Tangshan city and Jingmei community in Beijing city in July 2012.After a mean follow-up time of 47.2 month,the potential effects of different amounts of vegetables,fruits and F&V consumption on the new incidence of hypertension were studied and compared with univariant by multivariant Cox regression method.Results A total of 10 104 completed the follow-up survey and 576 cases of new hypertension were recorded.The incidence of hypertension in participants with ≤2,>2.0-<4.1-<5.0,≥5.0 serving F&V per day was 6.2%,6.0%,5.1% and 4.6%,respectively.With comparison to those participants consuming the lowest amount of vegetables,fruits and F&V,the hazard ratio for reducing the risk of hypertension and the 95% confidence intervals were 0.62 (0.46-0.83),0.87(0.78-0.97) and 0.69(0.54-0.80) for separate vegetables and fruits and total F&V(P<0.05).Conclusion Increasing the consumption of vegetables and fruits can significantly bring down the incidence of hypertension in North China populations.
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Objectives@#To investigate the social support status, related influential factors and the impact on one year outcome in patients with acute coronary syndrome (ACS), our data might be helpful to provide basis for making new treatment strategy aimed at improving social support for patients with ACS.@*Methods@#From January 2013 to June 2014, a total of 778 hospitalized patients with ACS were enrolled in the study. All patients completed enhancing recovery in coronary heart disease patients social support inventory(ESSI), general anxiety disorder scale(GAD-7), patient health questionnaire(PHQ-9), short-form 12 health survey questionnaire(SF-12), sleep questionnaire and demographic questionnaire within 7 days after admission and at 6 months and one year post discharge. Multiple linear regressions were performed to analyze factors that influenced the social support.@*Results@#The total score of social support was 17.08±3.61, 17.72±3.04, and 17.76±3.05 respectively in patients with ACS at baseline, 6 months and 12 months after discharge. Patients had a higher point of social support at 6 months (t=-2.69, P<0.01) and 12 months (t=-2.86, P<0.01) after discharge than at baseline. Multiple regression analysis for baseline data identified five significant predictors of low social support status: workers or farmers (t=2.82, P<0.01), low family monthly income (t=2.42, P<0.05), anxiety (t=-3.66, P<0.01), depression (t=-3.22, P<0.01) and low quality of life (t=4.38, P<0.01).@*Conclusions@#Social support of patients with ACS is lower in China, and there are significant relationships between low social support and occupation, economic status, anxiety, depression, quality of life of ACS patients.
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Objective@#To explore the efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model.@*Methods@#This study was a prospective randomized controlled study, 80 patients from Beijing Electrical Power Hospital and Beijing Jingmei Group General Hospital with acute coronary syndrome were included from June to December 2015 and divided into 2 groups. Patients in rehabilitation group (n=52) received tertiary hospital(Peiking University Peoples′ Hospital) guided and community-driven family self-help cardiac rehabilitation for 3 months, and patients in control group (n=28) received routine secondary treatment for 3 months. Following parameters including 6 minutes walk distance, score of life quality (evaluated by Short Form-12), score of anxiety (evaluated by Generalized Anxiety Disorder-7), score of depression (evaluated by Perceived Health Questionnaire-9), self-management competency (evaluated by questionnaire) were collected at baseline and after treatment for 3 months.@*Results@#Compared with control group, 6 minutes walk distance was longer in rehabilitation group((60.2±6.8) meters vs. (24.9±10.5)meters, P<0.01). The difference values between after and before intervention of life quality scores((0.14±3.90)scores vs.(-7.44±5.85)scores, P>0.05), anxiety scores((-0.16±2.12 ) scores vs.(0.70±1.13)scores, P>0.05) and depression scores((-1.17±2.79) scores vs.(0.60±0.36)scores, P>0.05) were similar between the 2 groups. The amplification of patients with regular exercise (50.26% vs. 0, P<0.05), limit sugary foods usually and always (53.22% vs. 3.98%, P<0.05), eat 200-400 g fruits usually and always (78.61 % vs. 0, P<0.05), eat 300-500 g vegetables usually and always (9.74% vs. 0, P<0.05), and answering very confident to questions such as let the physicians know about your diseases (40.17% vs. 5.00%, P<0.05), know how to take medicines (44.52% vs. 5.00%, P<0.05), know how much exercise was right for yourself (26.43% vs.0, P<0.05) were significantly higher in rehabilitation group than in control group. There were no cardiac rehabilitation training related cardiovascular events.@*Conclusion@#Tertiary hospital guided and community-driven family self-help cardiac rehabilitation model is an effective and safe management model of cardiovascular disease in chronic phase, and it is necessary to further expand the study population to verify the efficacy of this model.
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Objective@#To evaluate the efficacy and safety of ivabradine for the treatment of Chinese patients with chronic heart failure based on the Chinese subgroup data of the systolic heart failure treatment with the If inhibitor ivabradine trial (SHIFT).@*Method@#A total of 6 558 stable outpatients who presented symptoms of heart failure, with a left ventricular ejection fraction (LVEF) ≤35%, sinus rhythms with a heart rate ≥70 bpm participated in the randomized, double-blind, placebo-controlled, international multicenter clinical study.The subset of Chinese patients with heart rate ≥75 bpm was enrolled in the post-hoc subgroup analyses.Patients were randomly allocated by computer-generated assignment through a telephone interactive voice response system to ivabradine group (starting dose 5 mg bid, which was then uptitrated to the maximum 7.5 mg bid) or matched placebo group.The clinical baseline characteristics of participants were obtained and analyzed.The primary outcome endpoint was a composite endpoint of cardiovascular death or hospitalization resulting from worsening HF.The primary safety endpoint included total incidence of adverse events during the study, bradycardia, and adverse visual reaction (phosphenes).@*Results@#A total of 49 Chinese centers enrolled a total of 225 patients with chronic heart failure, of whom, 106 patients were randomized to the ivabradine group and the other 119 patients to the placebo group, and the mean follow-up time was (15.6±5.1) months.By the end of the study, mean heart rate (71.0 bpm vs. 80.3 bpm, P<0.05) and incidence of the primary endpoint events (18.9% (20/106) vs. 31.9%(38/119), HR=0.56, 95%CI 0.33-0.97, P=0.039) were significantly lower, while the percentage of patients with improvement in heart functional class NYHA (53.8% (56/106) vs. 34.5% (41/119), P=0.006 1) was significantly higher in the ivabradine group than in the placebo group.The total number of adverse events (129 events, 49.6% PY) in the ivabradine group was lower than that in the placebo group (203 events, 50.8% PY). In the ivabradine group and the placebo group, there were respectively 2 patients (1.9%) and 0 patients experienced bradycardia, 3 patients (2.9%) and 1 patient (0.8%) experienced adverse visual reaction (phosphenes).@*Conclusions@#Ivabradine significantly reduced heart rate and improved the clinical outcomes and NYHA function class in Chinese patients with chronic heart failure, these beneficial effects are achieved without inducing remarkable adverse reactions.The results of Chinese subgroup analysis were thus consistent with the overall results of the SHIFT study.@*Clinical Trial Registry@#International standard randomized controlled trials registry, ISRCTN 70429960.
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Objective: To understand the gender disparity and influencing factors for in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) at secondary hospitals in China. Methods: A total of 5525 in-hospital STEMI patients from 99 secondary hospitals of 15 provinces or autonomous regions between 2011-09 to 2014-06 were recruited including 1649 female and 3876 male. The in-hospital mortalities were compared between 2 genders and the relevant inlfuencing factors were studied by multiple Logistic regression analysis. Results: There were about 29.8% female and 70.2% male STEMI patients were studied. The in-hospital mortalities in female and male were 13.2% and 5.9%,P<0.01; gender disparity was obviously existing regardless of age, history of MI, hypertension and diabetes mellitus. The mortality in female was higher than male even without diseases history and cardiovascular risk factors. Compared with male gender, female patients were usually having elder age and likely complicated with cardiovascular risk factors; they were with lower incidence to receive ECG, drug therapy and thrombolysis within 10 minutes of admission. With adjusted confounding factors, multiple regression analysis presented that female STEMI patients had the higher mortality than male (OR:1.7, 95% CI:1.4-2.0). Conclusion: The in-hospital mortality for STEMI patients was higher in female than male at secondary hospitals in China. Female patients were usually having elder age, complicated with more cardiovascular risk factors, while with less chances to receive ECG, drug therapy and thrombolysis within 10 minutes of admission.
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Objective: To analyze the current status of anticoagulant therapy for in-hospital patients with acute coronary syndromes (ACS) at county hospitals of China and to explore the relationship between anticoagulant therapy and clinical outcomes in real medical environment. Methods: 99 county hospitals from15 provinces of China were selected for this prospective registry study and 12373 eligible ACS patients without interventional therapy admitted from 2011-09 to 2014-06 were enrolled. The basic condition, previous history, initial assessment, anticoagulants (unfractionated heparin/low molecular weight heparin) application, severe bleeding events and in-hospital mortality were collected in all patients. Multiple logistic regression analysis was conducted to explore the relationship between anticoagulant therapy and clinical outcomes including in-hospital mortality, severe bleeding events and combined endpoints; meanwhile, possible confounders were adjusted. Results: A total of 9985/12373 ACS patients received anticoagulant therapy and 2388 did not. Anticoagulant therapy was conducted in 92.7% (4237/4570) patients with ST-segment elevation myocardial infarction (STEMI), 90.8% (1639/1805) with non-ST-segment elevation myocardial infarction (NSTEMI) and 68.5% (4109/5998) with unstable angina (UA); there were differences by regions and genders,P0.05. Meanwhile, it did not increase the risk of severe bleeding events in ACS patients,P>0.05. Conclusion: Anticoagulant therapy has been widely used in STEMI and NSTEMI patients at county hospitals of China and obviously decreased the in-hospital mortality; while the application rate was relatively low in UA patients. The general safety of anticoagulant therapy has been good in ACS patients.
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<p><b>OBJECTIVE</b>To observe the current status of β-blocker (BB) use and heart rate control in Chinese patients with stable coronary artery disease (SCAD) based on subgroup data of the prospective observational longitudinal registry of patients with stable coronary artery disease (CLARIFY).</p><p><b>METHODS</b>The CLARIFY study is an international prospective observational registry of outpatients with SCAD. From November 2009 to July 2010, patients with SCAD were enrolled, and demographic information, clinical indicators, medication and blood flow reconstruction were collected. Patients were divided in three mutually exclusive categories by baseline pulse palpation heart rate(HR)≤60 beats per minute (bpm)(n=397), 61-69 bpm(n=782), and ≥70 bpm(n=1 443). The patients were also divided into taking BB or not taking BB groups. The aim of present study is to describe and analyze the current status and factors related to the HR control and BB use in the Chinese subgroup of CLARIFY.</p><p><b>RESULTS</b>A total of 2 622 patients were enrolled from 56 centers across China. The mean age was (63.6±10.3) years old with 75.6% (1 983) male patients, 55.0% (1 443) patients had HR≥70 bpm. Mean HR measure by electrocardiogram(ECG) was (69.4±10.2)bpm, 50.9% (1 334 cases) patients had myocardial infarction(MI) history. A total of 21.9%(575 cases) patients had anginal symptoms; coronary angiography was performed in 88.8%(2 327 cases) of the patients. 76.2%(1 997 cases) patients were treated with BB (any molecule and any dose), 2.7% (70 cases) with digoxin or derivatives, 3.9% (103 cases) with verapamil or diltiazem, and 1.8% (47 cases) with amiodarone or dronedarone and 0.1%(2 cases) received ivabradine. BB use was similar among 3 HR groups(P>0.05). The independent risk factors associated with HR≥70 bpm were diabetes(OR=1.31), current smoker(OR=1.57), chronic heart failure(CHF) with NYHA Ⅲ (OR=2.13) and increased diastolic blood pressure (OR=1.30). Conversely, high physical activity (OR=0.61), former smoker (OR=0.76) and history of percutaneous coronary intervention(PCI, OR=0.80) were associated with lower risk of HR≥70 bpm (all P<0.05). The independent risk factors associated with non-BB use were older age (OR=1.11, 95%CI 1.01-1.47, P=0.005), lower diastolic blood pressure (OR=1.47, 95%CI 1.32-1.68, P=0.012), no history of MI (OR=1.86, 95%CI 1.43-2.44, P<0.001) or PCI (OR=1.94, 95%CI 1.55-3.73, P<0.001), asthma/chronic obstructive pulmonary disease (OR=1.32, 95%CI 1.15-1.99, P<0.001).</p><p><b>CONCLUSIONS</b>A total of 76.2% Chinese SCAD patients received BB medication but more than half of them did not reach the optimal HR. Clinical characteristics including diabetes, current smoker, CHF, increased diastolic blood pressure and no PCI were associated with poorly controlled HR(≥70 bpm). More efforts including adjusting the type and dose of heart rate lowering drugs are needed to achieve optimal HR control in Chinese SCAD patients. Clinical Trail Registry International Standard Randomized Controlled Trial, ISRCTN43070564.</p>
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Female , Humans , Male , Middle Aged , Adrenergic beta-Antagonists , Angina Pectoris , Benzazepines , Blood Pressure , Coronary Angiography , Coronary Artery Disease , Electrocardiography , Heart Failure , Heart Rate , Myocardial Infarction , Outpatients , Percutaneous Coronary Intervention , Prospective Studies , Registries , Risk FactorsABSTRACT
Objective This study was aimed to investigate the relationship between serum leptin,adiponectin,visfatin levels and obesity and essential hypertension in female subjects.Methods According to BMI and blood pressure,206 female participants enrolled were divided into four groups:group 1:obesity and hypertension (48 cases);group 2:non-obesity but hypertension (48 cases);group 3:obesity and normotension (56 cases) and group 4:normal BMI and blood pressure (54 cases).Serum leptin,adiponectin and visfatin levels were detected and their relationships to BMI,blood pressure and waist circumference were analysed.Results Serum leptin levels were significantly higher in non-obese groups [group 2:(4.47 ±1.26) ng/L,group 4:(3.73-±1.18)ng/L] than in obese groups [group 1:(2.97 ± 1.46) ng/L,group 3:(3.02 ± 1.18) ng/L],and higher in hypertension groups than in normotension groups.Serum adiponectin levels were obviously higher in group 4 [38.99 (19.75,103.71) μg/L] than in the other three groups.There were no significant differences in adiponectin levels among group 1,2 and 3.Serum levels of visfatin were lower in normotension groups [group 3:3.19 (0.96,9.45) ng/L;group 4:3.23 (1.92,4.64) ng/L] than in hypertension groups [group 1:3.84 (3.40,5.35) ng/L;group 2:3.75 (1.63,6.67) ng/L] irrespective of obesity.Logistics regression analysis showed that there was 1.6％,8.3％,or 5.45％ increased risk for hypertension for each 1 μg/L decrease in adiponectin,1 cm increase in waist circumference,or 1 μg/L increase in visfatin level in obesity,respectively.No relationship could be viewed between leptin and hypertension.Conclusions Adiponectin and visfatin levels were correlated with obesity and blood pressure in females.Both adipokines may play a crucial role in the development of hypertension in female obesity.
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Objective To investigate the perception of anticoagulant treatment for atrial fibrillation (AF) in physicians from county-level hospitals.Methods Two hundred and ninety two physicians from 9 hospitals of Jiangsu,Henan,Zhejiang,Jiangxi provinces were enrolled in this cross-sectional survey from June to November 2013.A standard questionnaire was used in the survey,which consisted of questions on knowledge,awareness and concerns of physicians regarding the diagnosis of atrial fibrillation and administration of warfarin.Results Total 292 questionnaires were returned and 208 of them were finally analyzed.According to the reports of the physicians,the percentage of anticoagulant treatment was 30.0％ (10.0％-60.0％) in patients with rheumatic valvular AF,20.0％ (10.0％-50.0％) in patients with non-valvular AF and 80.0％ (40.0％-100.0％) in those with mechanical heart valve replacement.The most common concerns of prescribing warfarin were worries about the bleeding related to warfarin (74.0％,154),the necessary of monitoring INR (65.4％,136) and advanced age (44.7％,93).A half of physicians (51.0％,106) thought that ECG was the main means for diagnosis of AF and only 28.3％ (59) used both ECG and Holter as diagnosis procedure.Among the physicians who reported to use INR for monitoring warfarin administration,62.5％ (130) reported a target ranging 2-3 and one third reported a target INR ＜ 2.The proportion of the physicians who were aware of CHADS2 score and CHA2DS2-VASc score was 51.0％ (106) and 41.3％ (86),but only 15.4％ (32) and 6.3％ (13) of them knew the correct answer of the risk factors,respectively.Although 34.6％ (72) physicians were aware of HAS-BLED score,only 5.3％ (11) selected the 9 parameters correctly.68.3％ (142) physicians reported that vitamin K is the antidote for warfarin.Conclusion This study reveals the concerns and deficits in perception of anticoagulant treatment for AF patients in physicians of county-level hospitals,suggesting that education programs are needed to increase the prevalence of warfarin use in patients with AF.
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Objective The aim of this study was to investigate the differences on origin distribution and radiofrequency ablation characteristics between premature ventricular contractions (PVC) from left and right ventricular.Methods A total of 354 frequent PVC patients were enrolled.Two hundred and eighty patients were PVCs with right ventricular origin (group RV) and 74 patients with left ventricular origin (group LV).The age,gender,ablation power,temperature and duration,time of target potential before QRS onset,fluoroscopic time,procedure time and success rate were compared between the two groups.Results Majority PVCs (79.10％) were of right ventricular origin,in which the most common site was at right ventricular outflow tract (RVOT) (55.93％);whereas,only 20.90％ were of left ventricular.There were significantly differences between group RV and group LV in age [(44.7 ± 13.6) yrs vs (49.6 ±15.9) yrs,P =0.017],gender [male:35.4％ (99) vs 55.4％ (41),P =0.002],time of target potential before QRS onset [(37.9 ± 16.2) msvs (31.3 ± 11.7) ms,P=0.008],procedure time [(85.1 ± 36.9) minvs (100.8 ± 45.5) min,P=0.017],fluoroscopic time [(12.3 ± 9.2) min vs (15.9± 10.8) min,P =0.028] and success rate (96.4％ vs 89.2％,P =0.012).Conclusions Radiofrequency ablation of PVCs was a safe and effective method.Subjects with RV PVCs are younger and more females than subjects with LV PVCs.The radiofrequency ablation for RV PVCs was easier,and the success rate was higher than that for LV PVCs.
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Objective To investigate impact of admission renal dysfunction on in-hospital and longterm outcome of patients with ST-elevation myocardial infarction (STEMI).Methods This was a multicentre,observational,prospective-cohort study.Totally 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI.Estimation of glomerular filtration rate (eGFR) was calculated according to the abbreviated MDRD equation.The patients were categorized into two groups as renal preservation group(eGFR ≥60 ml · min-1 · 1.73 m-2) and renal dysfunction group(eGFR ＜ 60 ml ·min-1 · 1.73 m-2).The association between admission renal dysfunction and in-hospital and six-year outcome was evaluated.Results A total of 718 patients with STEMI were evaluated.There were 551 men and 167 women with age of (61.0 ± 13.0) years.One hundred and thirty-three patients(18.5％) had renal dysfunction.Patients with renal dysfunction were more often female and older,more patients had hypertension,diabetes and heart failure,and more patients had ≥ Killip Ⅱ classes on admission.These patients were less likely to present with chest pain.The in-hospital mortality(16.5％ vs 2.6％,P＜0.001),major adverse cardiac events(MACE) (60.9％ vs 24.4％,P ＜0.001),six-year all-cause mortality(35.3％vs 11.4％,P ＜ 0.001),six-year cardiac mortality (15.9％ vs 5.7％,P =0.001) and six-year MACE (52.4％ vs 28.0％,P ＜ 0.001)were markedly increased in renal dysfunction group than in renal preservation group.After adjusting for other confounding factors,renal dysfunction was an independent predictor of in-hospital MACE (OR 2.120,95％ CI 1.563-2.878,P =0.003),six-year all-cause mortality (RR 2.122,95％ CI 1.127-3.996,P =0.020) and six-year MACE(RR 1.586,95％ CI 1.003-2.530,P =0.047).Conclusions The mortality and MACE in STEMI patients with renal dysfunction were higher than in those with preserved renal function.Renal dysfunction evaluated by eGFR on admission is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.
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<p><b>OBJECTIVE</b>To observe the early reperfusion therapy status for patients with ST elevation acute myocardial infarction (STEMI) hospitalized in tertiary and secondary hospitals in Henan province.</p><p><b>METHODS</b>Baseline data, early reperfusion treatment and in-hospital mortality of STEMI patients hospitalized in 17 hospitals in Henan province (8 tertiary hospitals, 9 secondary hospitals) from June 2011 to June 2012 were obtained using a uniformed questionnaire.</p><p><b>RESULTS</b>One thousand six hundred and eighty six patients were enrolled, of which 886 patients were hospitalized in tertiary hospitals and 880 patients were early hospitalized in secondary hospitals. Six hundred and fifty four patients (38.8%, 654/1 686) underwent early reperfusion therapy (543 with thrombolysis and 111 with primary percutaneous coronary intervention (PCI)). There was no difference in the proportion of early reperfusion therapy between tertiary and secondary hospitals (40.1% (355/886) vs. 37.4% (299/800), P = 0.257). The median time from symptom onset to first medical contact, door-to-needle and door-to-balloon was 132 min, 18 min and 60 min, respectively. The median time from symptom onset to first medical contact (150 min vs. 120 min, P = 0.001), door-to-needle (30 min vs. 18 min, P = 0.003) and symptom onset-to-thrombolysis (3.5 h vs. 2.7 h, P = 0.001) were significantly longer in tertiary hospitals than in secondary hospitals. No difference was found in median time of door-to-balloon, symptom onset-to-primary PCI or symptom onset-to-elected PCI between tertiary and secondary hospitals (all P > 0.05). The proportion of door-to-needle ≤ 30 min was lower in tertiary hospitals than in secondary hospitals (46.4% (84/181) vs. 62.2% (153/246), P = 0.001). However, there was no difference in the proportion of door-to-balloon ≤ 90 min between tertiary and secondary hospitals (58.8% (60/102) vs. 57.1% (4/7), P = 1.000). In-hospital mortality was also similar between tertiary and secondary hospitals (5.8% (51/886) vs. 5.5% (44/800), P = 0.820).</p><p><b>CONCLUSIONS</b>Early reperfusion rate is low, and thrombolysis is the main early reperfusion therapy in both tertiary and secondary hospitals in Henan province. Tertiary hospitals did not take advantage of their primary PCI capability. There is great room for improvement in early reperfusion therapy in tertiary and secondary hospitals.</p>
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Humans , Hospital Mortality , Hospitals , Myocardial Infarction , Myocardial Reperfusion , Percutaneous Coronary Intervention , Secondary Prevention , Surveys and QuestionnairesABSTRACT
<p><b>OBJECTIVE</b>To explore if the new onset hypertension was related with metabolic risk factors and lifestyle in Beijing community residents to guide the targeted prevention of hypertension.</p><p><b>METHODS</b>A population-based survey with a randomly cluster sampling was made to observe the relationship between metabolic risk factors and lifestyle with new onset hypertension by multivariate and logistic regression.</p><p><b>RESULTS</b>A total of 4 034 subjects with normal blood pressure at baseline were included and 978 (24.2%) residents developed hypertension two years later. Multiple logistic analysis demonstrated that risk factors that contributed to new onset hypertension were prehypertension, overweight, obesity, frequent alcohol drinking, metabolic syndrome (MS), age and male gender, the respective Odds Ratios(OR) and 95% confidence interval (95%CI) are as follows: 3.512 (2.965-4.168), 1.654 (1.423-1.918), 2.264 (1.633-2.951), 1.493 (1.231-1.775), 1.329 (1.227-1.414), 1.226 (1.115-1.335), 1.135(1.018-1.221). College education serves as the protective factor, and the OR (95%CI) was 0.692 (0.476, 0.897).</p><p><b>CONCLUSIONS</b>New onset hypertension in Beijing community residents is mainly related with prehypertension, overweight or obesity, MS, frequent alcohol drinking and low education level. We should pay more attention to modulating metabolic risk factors and lifestyle to reduce the new onset hypertension in China.</p>
Subject(s)
Humans , Male , Beijing , Blood Pressure , China , Hypertension , Life Style , Logistic Models , Metabolic Syndrome , Overweight , Prehypertension , Risk FactorsABSTRACT
<p><b>OBJECTIVE</b>To analyze the value of 2- and 9-question patient health questionnaires (PHQ-2 and PHQ-9) for screening status of depression in cardiovascular outpatients.</p><p><b>METHODS</b>From June 2013 to January 2014, a total of 201 outpatients from psycho-cardiological outpatients departments were consecutively enrolled into this study. All patients were asked to complete PHQ-9 and the mental psychological assessment by qualified researchers trained by psychiatry according to the composite international diagnostic interviews (CIDI), 50 cases were retested to assess the retest reliability after one week. The PHQ-2 and PHQ-9 were validated with the CIDI as the reference criteria.</p><p><b>RESULTS</b>According to the CIDI, 42 (21.3%) out of the 201 outpatients were diagnosed as depression. For PHQ-9 scale, a cutoff value of 10 presented satisfactory results with 87.1% sensitivity, 83.5% specificity, 58.7% positive predicting value, 95.6% negative predicting value and the area under the ROC curve (AUC) was 0.877 (SE = 0.032, 95% CI: 0.813-0.938). The Cronbach's alpha coefficients and test-retest reliability of the PHQ-9 were 0.809 and 0.882, respectively. Compared with CIDI, the cutoff value of the PHQ-2 was 3 with 85.7% sensitivity, 69.2% specificity, 57.1% positive predicting value, 93.6% negative predicting value, and the AUC was 0.806 (SE = 0.042, 95% CI: 0.774-0.889). The Cronbach's alpha coefficients and test-retest reliability of the PHQ-2 were 0.785 and 0.813, respectively.</p><p><b>CONCLUSION</b>The PHQ-2 and PHQ-9 are reliable and efficient instruments for screening and especially excluding depression in cardiovascular outpatients.</p>
Subject(s)
Humans , Area Under Curve , Cardiovascular Diseases , Psychology , Depression , Diagnosis , Mass Screening , Outpatients , Psychology , Reproducibility of Results , Sensitivity and Specificity , Surveys and QuestionnairesABSTRACT
Objective To evaluate the gender difference in the prognostic value of admission renal dysfunction (RD) for patients with acute ST-segment elevation (STEMI).Methods This was a multicenter,prospective cohort study.Four hundred and fifty STEMI patients within 24 h of onset and discharged successfully from 19 hospitals in Beijing were included in the study.All the patients were followed up six years later.According to gender,patients were categorized into two groups.Clinical characteristics,reperfusion therapy conditions and outcomes were analyzed.Multivariate Cox regression analysis was used to evaluate the possible gender difference in the prognostic value of RD.Results Among all the subjects,342 were men and 108 were women with age of (61.3 ± 12.5) years.Compared to man patients,women were older (P ＜ 0.001),and more subjects were with hypertension (67.6％ vs 49.7 ％,P =0.005),stroke (15.7％ vs 8.8％,P =0.039) and RD (17.9％ vs 6.7％,P =0.001).After adjustment of age,past medical history,and acute reperfusion therapy.Cox regression analysis showed that RD was associated with the risk of all-cause mortality (HR 3.771,95％ CI 1.382-10.294,P =0.010) and major adverse cardiovascular events (MACE,HR 2.292,95％ CI:1.091-4.817,P =0.029) in male patients.However,the associations between RD and all-cause mortality(HR 0.889,95％ CI 0.241-3.281,P =0.859),and MACE(HR 1.508,95％ CI 0.616-3.693,P =0.368)were disappeared in women.The interaction test showed that there existed significant interactions between gender and RD in all-cause mortality(HR 2.709,95％CI 1.150-6.384,P =0.023)and MACE(HR 1.977,95％ CI 1.009-3.876,P =0.023).Conclusions There is a considerable gender difference in the prognostic value of RD for the outcomes in patients with STEMI.RD seemed to be an important prognostic maker in male patients.