Difficulties of Portuguese Patients Following Acute Myocardial Infarction: Predictors of Readmissions and Unchanged Lifestyles

PURPOSE: Myocardial infarction can occur due to known risk factors and lifestyle choices. The difficulties that patients experience after discharge can lead to readmission and nonadherence to lifestyle change. The purpose of this study was to analyze the difficulties experienced by patients after hospitalization due to myocardial infarction and to identify the predictors of readmission and unchanged lifestyles. METHODS: The study used a mixed-methods design across 106 patients who had experienced a first episode of acute myocardial infarction. The data were collected from two patient interviews and the patients' medical records. A logistic regression was used to predict unchanged lifestyle and readmission. RESULTS: In the first interview, 74.5% of the patients reported receiving information prior to discharge. Six months after discharge, 80.2% mentioned that they had changed their lifestyles, but only 59.4% reported that their health had improved, and 75.5% continued to have concerns regarding their health. Patients described difficulties with regard to psychological problems, family dynamics, professional issues, problems with managing cardiovascular symptoms, and complications associated with hospital interventions. A follow-up assessment revealed that 12.3% of patients had been readmitted for cardiovascular disease. CONCLUSIONS: The analysis revealed significant predictors of readmission amongst patients with hypertension and three-vessel disease. Specifically, the number of people in the household, per capita income, and a lack of information/education provided at discharge as well as problems related to mental health after discharge predicted unchanged lifestyle. An educational program might be advantageous to clarify doubts and involve patients in their own disease management.

Infarto agudo del miocardio por estrés laboral / Acute myocardial infarction by work stress

En Medicina del Trabajo del Departamento de Medicina Legal se atienden casos de enfermedad laboral, donde el estrés laboral ha aumentado su incidencia como factor predisponerte de enfermedades profesionales destacando el infarto agudo del miocardio como una de ellas. Este artículo pretende revisar los criterios diagnósticos del infarto del miocardio, factores de riesgo, mecanismos y síntomas del estrés laboral, rehabilitación postinfarto y recomendaciones para la prevención de las enfermedades cardiovasculares.

We evaluated a patient who was working for a public institution that provides care for all types of emergencies, was subjected daily to a great stress at work one day showed typical chest pain and was managed as an acute coronary syndrome. This article reviews the diagnostic criteria for heart attack, risk factors, mechanisms and symptoms of work stress, post heart attack rehabilitation and recommendations for prevention of cardiovascular disease.

Acute myocardial infarction in the West Indies early observations, current issues and future concerns / Infarto agudo del miocardio en el Caribe Occidental primeras observaciones, problemas actuales, e inquietudes futuras

In the epidemiological transition from infectious diseases in the Caribbean, chronic non-communicable diseases, including cardiovascular disease, have emerged as important public health interest. Although hypertensive heart disease predominates in Afro-Caribbean populations, ischaemic heart disease and acute myocardial infarction have also been present, but the prevalence has been somewhat under-appreciated.

En la transición epidemiológica de las enfermedades infecciosas en el Caribe, las enfermedades crónicas, no comunicables, incluyendo las enfermedades cardiovasculares, se han convertido en asunto de importante interés para la salud pública. Aunque la cardiopatía hipertensiva predomina en las poblaciones afrocaribeñas, la cardio-patía isquémica y el infarto agudo del miocardio también han estado presentes, pero su prevalencia ha sido de cierto modo subestimada.

Two-year mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary artery disease risk factors in patients presenting with acute myocardial infarction(AMI) to a tertiary care institution in Trinidad and to determine the factors associated with increased mortality following AMI. All patients admitted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the hospital admissions and discharge diagnosis databases. Demographic, clinical and laboratory variables were extracted from the hospital case records of patients with confirmed AMI. Sixty-one AMI patients (38 men) were admitted during the study period. Mean age of admittance was 60 ñ 11 years with an ethnic case mix of thirty-nine (62 percent) of East Indian descent, eight (13 percent) of African descent, twelve (20 percent) mixed ethnicity and three of Caucasian descent. Thirty patients (49 percent) were hypertensive. Thirty-two patients (53 percent) were diabetic and eighteen patients (30 percent) gave a history of cigarette smoking. The mean left venticular ejection fraction was 53 ñ 14 percent. The mean serum cholesterol from 29 patients was 228.2 ñ 49.0 mg/dl. Increasing age, female gender, an ejection fraction less than 40 percent, non treatment with streptokinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predictors of mortality. These were gender (p = 0.04), in-hospital ventricular fibrillation (p = 0.001) and an ejection fraction less than 40 percent (p = 0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevalent amongst patients presenting with AMI. Ventricular function was a major determinant of two-year mortality following AMI. Aggressive risk factor modification is recommended to prevent both first and recurrent coronary events.