The predicted impact of heart disease prevention and treatment initiatives on mortality in Lithuania, a middle-income country.

INTRODUCTION: Disease-prevention programs compete with disease-treatment programs for scarce resources. This analysis predicts the impact of heart disease prevention and treatment initiatives for Lithuania, a middle-income Baltic country of 3.3 million people. METHODS: To perform the analysis, we used data from clinical trials, the Lithuanian mortality registry, the Kaunas Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) register, Kaunas University Hospital and, when data from Lithuania were not available, the United States. We used the predicted reduction in all-cause mortality (as potentially postponable deaths) per 100,000 people aged 35 to 64 years as our outcome measure. RESULTS: The number of potentially postponable deaths from risk factor prevention and management in the population without apparent heart disease is 556.3 (plausible range, 282.3-878.1). The number of potentially postponable deaths for people with stable heart disease is 280.4 (plausible range, 90.8-521.8), 7.0 with a public-access defibrillator program (plausible range, 3.8-8.9), and 119.0 for hospitalized patients (plausible range, 15.9-297.7). CONCLUSION: Although improving treatment of acute events will benefit individual patients, the potential impact on the larger population is modest. Only programs that prevent and manage risk factors can generate large declines in mortality. Significant reductions in both cardiac and noncardiac death magnify the impact of risk-factor prevention and management.

[Physical and mental health of stroke survivors and their daily activities]. / Persirgusiuju galvos smegenu insultu fizine ir psichine sveikata bei kasdiene veikla.

UNLABELLED: The aim of the study was to compare the quality of life between stroke survivors and controls with respect to their health, daily activities, and emotional status. CONTINGENT AND METHODS OF THE STUDY: The studied group consisted of 508 25-84-year-old inhabitants of Kaunas city who have survived first-onset stroke. The control group consisted of 508 age- and sex-matched randomly selected inhabitants of Kaunas city who had not experienced stroke. The SF-12 Quality of Life Questionnaire was used for the study. Logistic regression was used to compare quality of life with respect to health, daily activities, and emotional status. RESULTS: Only 1.0% of stroke survivors evaluated their health as excellent or very good, compared to 24.4% of the controls (P=0.0005); the respective percentages of those who evaluated their health as poor or fair were 78.9% and 26.4% (P=0.0005). Health significantly limited moderate activities in 35.2% of stroke survivors and 3.5% of controls (P=0.0005). During the last 4 weeks, health status or emotional problems most of the time or a little of the time impeded social activities in 19.3% of stroke survivors and 1.6% of controls (P<0.05). When comparing with respect to age, sex, and diseases (arterial hypertension, myocardial infarction, atrial fibrillation, diabetes mellitus, transient ischemic attack), stroke had the greatest negative effect on social activities (odds ratio, 36.7), caused sadness (odds ratio, 16.0), and significantly limited home activities (odds ratio, 15.5). CONCLUSIONS: Less that one-third (28.2%) of stroke survivors evaluated their health as poor, and 50.7% as fair as compared to 1.8% and 24.6% of controls, respectively. Stroke significantly impaired the subjects' emotional status and limited their daily activities.

The dependence of successful resuscitation on electrocardiographically documented cardiac rhythm in case of out-of-hospital cardiac arrest.

OBJECTIVE: To determine the influence of electrocardiographically documented cardiac rhythm during sudden cardiac arrest on successful resuscitation among out-of-hospital deaths in Kaunas city. MATERIAL AND METHODS: An observational prospective study was conducted between 1 January, 2005, and 30 December, 2005, in Kaunas city with a population of 360,627 inhabitants. In this period, all cases of cardiac arrest were analyzed according to the guidelines of the Utstein consensus conference. Cardiac arrest (both of cardiac and noncardiac etiology) was confirmed in 72 patients during one year. Effective cardiopulmonary resuscitation was performed in 18 patients. RESULTS: The total number of deaths from all causes in Kaunas during 1-year study period was 6691. Sixty-two patients due to sudden death of cardiac etiology were resuscitated by emergency medical services personnel. Return of spontaneous circulation was achieved in 11 patients. Ventricular fibrillation was observed in 33 (53.2%) patients. Asystole was present in 11 (17.7%) and other rhythms in 18 (29.1%) cases. Patients with ventricular fibrillation as an initial rhythm were more likely to be successfully resuscitated than patients with asystole. CONCLUSIONS: Ventricular fibrillation was the most common electrocardiographically documented cardiac rhythm registered during cardiac arrest in out-of-hospital settings. Ventricular fibrillation as a mechanism of cardiac arrest was associated with major cases of successful resuscitation.

Short-term and one-year prognosis of diabetic patients with a first-ever myocardial infarction.

OBJECTIVES: To clarify the importance of clinical features and changes in the first electrocardiogram in 28-day and 1-year mortality in patients with diabetes. MATERIAL AND METHODS: Men and women of Kaunas city aged 25-64 years with the first-ever myocardial infarction during 1983-1992 and with the first electrocardiogram were enrolled in the study. Electrocardiograms were coded using the WHO MONICA Project Protocol criteria and the Minnesota Code. The Kaunas Ischemic Heart Disease Register was the source of data; deaths from ischemic heart disease were identified via death register. RESULTS: Diabetes was diagnosed in 124 patients: 65 (52.4%) men and 59 (47.6%) women. The 28-day (P=0.01) and 1-year mortality rates (P<0.001) were higher in diabetic than in nondiabetic patients with myocardial infarction. Among diabetic patients, who died during 28 days or one year, myocardial infarction was more often complicated by acute heart failure, and changes in ECG were more often detected than among those who were alive. Female gender (RR=30.2, P=0.02) was associated with an increased risk of death from a first-ever myocardial infarction during the first 28 days, while acute heart failure (RR=4.48, P=0.01) and anterior location of Q wave in the first ECG (RR=2.71, P=0.04) increased the risk of death from ischemic heart disease during one year after a first-ever myocardial infarction. CONCLUSIONS: Acute heart failure and Q-wave in derivations of the first electrocardiogram reflecting anterior site of myocardial infarction increased the risk of death from ischemic heart disease during the first year, and female gender--during the first 28 days in diabetic patients with myocardial infarction.

Sex differences in one-year mortality after a first-ever myocardial infarction.

OBJECTIVES: To determine the significance of sex in one-year prognosis of death from ischemic heart disease after a first-ever myocardial infarction. MATERIAL AND METHODS: Kaunas men and women aged 25-64 years and admitted to the hospitals of Kaunas due to a first-ever myocardial infarction during 1983-1992, and with a first coded electrocardiogram were enrolled into the study. Electrocardiograms were analyzed using the criteria of the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Project of World Health Organization (WHO) and the Minnesota Code. The Kaunas ischemic heart disease register was a source of data. RESULTS: Women with a Q-wave or non-Q-wave myocardial infarction were older; they had anterior localization of myocardial infarction, a history of diabetes and obesity more frequently than men. Myocardial infarction was more often complicated by atrial flutter or fibrillation (p=0.02) in women with Q-wave myocardial infarction than in men, and women with non-Q-wave myocardial infarction more frequently had history of hypertension than men (p=0.00). One-year mortality after a myocardial infarction was significantly higher in women with Q-wave myocardial infarction than in women with non-Q-wave myocardial infarction (p=0.03). There was no difference in odds to die during a first year after myocardial infarction with or without Q-wave between women and men neither in univariate nor in multivariate analysis. CONCLUSIONS: Women aged 25 to 64 years had similar crude risk of dying during one year after initial myocardial infarction compared with men of the same age group. There were no statistically significant differences between men and women with Q-wave or non-Q-wave myocardial infarction after adjustment for potential confounders.

Morbidity and mortality from the major cardiovascular diseases in Kaunas population from 1983 to 2002.

UNLABELLED: THE AIM of the present study was to evaluate the trends in morbidity and mortality from ischemic heart disease and stroke in Kaunas population aged 25-64 years from 1983 to 2002. MATERIAL AND METHODS: The source of data is the official mortality statistics and Kaunas population-based ischemic heart disease and stroke registers. The methods used for the data collection were those applied by the WHO MONICA project. The object - all permanent residents of Kaunas aged 25-64 years who died from ischemic heart disease and stroke in 1983-2002 and experienced ischemic heart disease or stroke in 1983-2000. The age-standardized rates were calculated by the direct method and using the Segi's World and European population as a standard. Trends were analyzed using the method of linear regression on logarithms of the age-standardized annual rates. RESULTS: During 1983 to 2000, the morbidity from acute myocardial infarction among Kaunas men aged 25-64 years decreased by 0.8%/yr. (p=0.08), and during 1986-2000, the morbidity from stroke among men of the same age was without significant changes (-0.4%/yr., p=0.5). Among women, both the morbidity from acute myocardial infarction (1.6%/yr., p=0.006) and the morbidity from stroke (2.9%/yr., p=0.000002) rates among women increased statistically significantly. During 1983 to 2002, the mortality rates from acute myocardial infarction and stroke decreased statistically significantly among both men and women: among men - by 2.2%/yr., p=0.003, and by 2.9%/yr., p=0.004, respectively; among women - by 2.6%/yr., p=0.005, and by 3.2%/yr., p=0.002, respectively. CONCLUSIONS: The morbidity of acute myocardial infarction and stroke remained without significant changes among Kaunas men aged 25-64 years, while it increased statistically significantly among women of the same age during the last two decades. Among both men and women the mortality rates from both ischemic heart disease and stroke decreased significantly from 1983 to 2002.