Subject(s)
Myocardial Infarction/epidemiology , Registries , Age Distribution , Aged , Female , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Spain/epidemiologyABSTRACT
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Subject(s)
Humans , Myocardial Infarction/epidemiology , Hospital Statistics , Myocardial Infarction/mortality , Spain/epidemiology , Epidemiologic Studies , Incidence , Critical Care/statistics & numerical dataABSTRACT
INTRODUCTION AND OBJECTIVES: Some authors have described seasonal variations in the incidence of acute myocardial infarction. The aim of this study was to determine the existence of seasonal rhythms in admissions for acute myocardial infarction to coronary care units, and in mortality, and to analyze the influence of age on environmental factors. PATIENTS AND METHOD: The study included a total of 8400 consecutive patients with acute myocardial infarction admitted to 12 coronary care units in the PRIMVAC registry from January 1995 to December 1999. Seasonal rhythms were analyzed with the time series method and the Cosinor regression equation. The influence of age was analyzed with the chi 2 test. RESULTS: The total number of admissions increased in winter and decreased in summer. The highest peak (acrophase) occurred in winter, with 2183 cases (r2=0.91), specifically in February, with 742 cases (r2=0.66). The age of the patients conditioned seasonal variations (P=.006), and the influence was statistically significant for patients over 65 years of age. Changes in mortality with time did not reach statistical significance. CONCLUSIONS: A seasonal rhythm in admissions for acute myocardial infarction was found, with an increase in winter and a decrease in summer. Age conditioned the effect of environmental factors on acute myocardial infarction, and patients aged 65 years or older were more sensitive to mechanisms that led to increases in admissions in winter.
Subject(s)
Myocardial Infarction/epidemiology , Seasons , Age Distribution , Aged , Cold Temperature , Humans , Incidence , Middle Aged , Registries , Regression Analysis , Spain/epidemiologyABSTRACT
Introducción y objetivos. Se ha descrito un aumento en la incidencia del infarto agudo de miocardio durante los meses fríos. Se pretende averiguar si existe un ritmo estacional en los ingresos por infarto en las unidades coronarias y en su mortalidad, y determinar si la edad condiciona el efecto de los factores ambientales. Pacientes y método. A partir del registro PRIMVAC, se estudió a 8.400 pacientes ingresados consecutivamente por infarto agudo de miocardio desde enero de 1995 a diciembre de 1999 en 12 hospitales de la Comunidad Valenciana. Se analizó el ritmo estacional mediante el estudio de series temporales y la ecuación de regresión Cosinor. El análisis de la influencia de la edad en los ingresos y la mortalidad se realizó mediante el test de la 2.Resultados. El número de ingresos por infarto agudo de miocardio aumentó en invierno y disminuyó en verano. El pico máximo (acrofase) se produjo en invierno, con 2.183 casos (r2 = 0,91), concretamente en el mes de febrero, con 742 casos (r2 = 0,66). La edad condiciona las variaciones estacionales en el número de ingresos (p = 0,006), con diferencias estadísticas a partir de los 65 años. Las variaciones en la mortalidad no alcanzan significación. Conclusiones. Existe un patrón estacional en los ingresos por infarto agudo de miocardio, con un aumento en el número de casos durante el invierno y un descenso durante el verano. La edad de los pacientes condiciona el efecto de los factores ambientales en el infarto. A partir de los 65 años, los sujetos son más sensibles a los mecanismos causantes del aumento de ingresos en invierno (AU)
Subject(s)
Middle Aged , Aged , Humans , Seasons , Spain , Incidence , Age Distribution , Myocardial Infarction , Registries , Regression Analysis , Cold TemperatureABSTRACT
The two main goals of chest pain units are the early, accurate diagnosis of acute coronary syndromes and the rapid, efficient recognition of low-risk patients who do not need hospital admission. Many clinical, practical, and economic reasons support the establishment of such units. Patients with chest pain account for a substantial proportion of emergency room turnover and their care is still far from optimal: 8% of patients sent home are later diagnosed of acute coronary syndrome and 60% of admissions for chest pain eventually prove to have been unnecessary.We present a systematic approach to create and manage a chest pain unit employing specialists headed by a cardiologist. The unit may be functional or located in a separate area of the emergency room. Initial triage is based on the clinical characteristics, the ECG and biomarkers of myocardial infarct. Risk stratification in the second phase selects patients to be admitted to the chest pain unit for 6-12 h. Finally, we propose treadmill testing before discharge to rule out the presence of acute myocardial ischemia or damage in patients with negative biomarkers and non-diagnostic serial ECGs.
